Wuxi’s urban employee medical insurance policies and reimbursement ratios were compiled and compiled by me. This article is for reference only. If the specific content changes, please refer to the official website. Medical insurance for urban employees is coordinated at the municipal level, with unified policies, unified standards, and unified handling procedures throughout the city. Wuxi Urban Employee Medical Insurance Policy Almost everyone has medical insurance. Everyone also knows that the medical insurance card not only wants to know more about Wuxi Urban Employee Medical Insurance policy and the reimbursement ratio, let’s take a look. Wuxi urban employee medical insurance policies and reimbursement ratios are compiled and compiled by. This article is for reference only. If the specific content changes, please refer to the official website. Medical insurance for urban employees is coordinated at the municipal level, with unified policies, unified standards, and unified handling procedures throughout the city. Wuxi Urban Employee Medical Insurance Policy Almost everyone has medical insurance. Everyone knows that medical insurance cards can not only be used to buy medicines in designated pharmacies, but can also be used in designated medical institutions. But when it comes to specific questions such as how to use it, detailed vouchers, etc., few can answer it. At the same time, for different groups of people (employees (retired employees), ordinary residents (including students, children)), the reimbursement ratios in various situations are also different. Therefore, here is a detailed introduction to different groups of people.

1. Wuxi Urban Employee Basic Medical Insurance Benefits (1) General Outpatient Clinic ◆Pay from personal account first, and can be used at designated medical institutions and designated retail pharmacies. ◆Outpatient coordination: Patients can sign a service agreement with a recognized community hospital for treatment, and can only use it after their personal account is used up. The actual maximum annual amount that can be enjoyed is: 5,000 yuan for working personnel and 6,000 yuan for retirees. The personal burden ratios of medical expenses within the system are: 30% and 15% respectively. The first diagnosis will be made by the contracted community health service center; if you need to go to other medical institutions for treatment, you should be transferred out of the contracted community health service center according to the needs of the condition. After completing the transfer procedures, you will be transferred to the medical institution to draw your card for medical treatment. ◆Outpatient chronic diseases: 12 kinds of chronic diseases such as hypertension and coronary heart disease: you should first go to a municipal hospital for identification, choose a medical institution that you think is convenient (cannot be a community health service center), and make an appointment with the medical institution as your own hospital. After registration and agreement at the center's offices in each district, for those under 70 years old, the personal out-of-pocket payment exceeds 800 yuan, and the medical insurance fund pays 70%. The maximum annual payment limit is 3,500 yuan; for retirees over 70 years old, the personal out-of-pocket payment exceeds 600 yuan. Yuan, the medical insurance fund pays 80%, and the maximum annual payment limit is 4,000 Yuan. (2) Ordinary hospitalization 1. Hospitalization expenses that meet the regulations: ◆Third-level hospital: discharge settlement at a third-level medical institution, medical expenses are less than 10,000 yuan (including 10,000 yuan), 84% of the employee's overall fund payment, personal The self-pay ratio is 16%; medical expenses range from 10,000 yuan to 40,000 yuan (including 40,000 yuan), the overall fund pays 88%, and the individual self-pay ratio is 12% (the individual self-pay ratio for retirees is 50% of the above standards) , the same below); ◆ Second-level and lower hospitals: discharge settlement in first-level and second-level medical institutions, if the medical expenses of active employees are less than 10,000 yuan (including 10,000 yuan), the overall fund pays 88%, and the individual out-of-pocket ratio is 12 %; medical expenses range from RMB 10,000 to RMB 40,000 (including RMB 40,000), 90% is paid by the overall fund, and 10% is paid by the individual (self-payment is halved in retirement); ◆Community hospital: discharged at the community health service center In settlement, if the medical expenses are less than 40,000 yuan (including 40,000 yuan), the overall fund will pay 92%, and the individual self-payment ratio is 8% (retirement self-payment is halved); 2. Large expenses: Medical expenses fund above 40,000 yuan The payment and personal out-of-pocket ratios are unified at 92% and 8%. 3. Initial hospitalization fee: The initial hospitalization fee (threshold fee) should be paid for the first hospitalization: 950 yuan for in-service and 750 yuan for retired hospitals; 750 yuan and 600 yuan for retired hospitals; 400 yuan for first-class hospitals and community health The service center fee is uniformly 300 yuan. The second hospitalization within the year is 50% of the above standard, and the third and subsequent hospitalization is 25% of the above standard. (3) Outpatient medical expenses for special diseases are exempt from the initial fee and enjoy hospitalization reimbursement treatment from first-level medical institutions. (4) Offices are hosted by the Wuxi Social Insurance Fund Management Center, and service windows are located in each district office. (5) Registration for medical treatment in another place. If you live for a long time or are stationed in a different place by the company for more than half a year, and need to seek medical treatment in another place, you can fill out the "Application Form for Medical Treatment in Another Place" (stamped with the seal of your unit and the office of the Social Security Center) Please go to the offices of the Social Security Center with your ID card and social security card to register for off-site medical treatment and receive the "Off-site Medical Treatment Certificate". You can choose three hospitals as designated hospitals in other places. Information required for reimbursement of medical treatment in another place: If you incur hospitalization expenses in another place and have filed for medical treatment in another place, please prepare the above information as soon as possible after discharge from the hospital and go to the offices of the Social Security Center for reimbursement: ◆Personal second-generation ID card, social security card ; ◆Outpatient medical records, discharge summary, valid bills and expense details; ◆Reminder medical certificate; ◆Personal bank card. (6) Employees’ medical insurance participants in Wuxi City (including Jiangyin and Yixing) who have received the “Jiangsu Province Social Security Card” through the Big City Card can apply for registration of the “Big City Card” at the social insurance agency within Wuxi City . Insured persons who have successfully registered can choose another place as a medical treatment place while maintaining the medical treatment benefits in the insured place.

You can use the "Jiangsu Province Social Security Card" to swipe the card for medical treatment at designated medical institutions.

2. Basic medical insurance benefits for urban residents in Wuxi (1) General outpatient services ◆50% for medical treatment at community health service centers, with a limit of 800 yuan (including the personal share within the scope of medical insurance); ◆In the city For medical treatment in hospitals outside the city and outside the city, the rate for those who have gone through the referral procedures is 45% respectively, and for those who have not gone through the referral procedures, the rate is 50% of the above ratio; Reimbursement ratio (2) General hospitalization and special cases should be first diagnosed at the community health service center. The starting fee for hospitalization medical expenses is 200 yuan, 90% of which is paid by the medical expenses fund that meets the regulations, and 10% is paid by the individual; for those transferred to other medical institutions in the urban area, the initial hospitalization fee is 300 yuan for students and children, and 600 yuan for other residents. , for hospitalization in second-level medical institutions or below, the fund pays 75% of the medical expenses that meet the regulations, and the individual pays 25%. For third-level medical institutions, the fund pays 65%, and the individual pays 35%. For transfers out of the urban area, the fund pays 55%. The individual pays 45% out of pocket. If the transfer procedures are not completed as required, the fund will pay 50% of the above standards. ◆Maximum limit: The maximum annual cumulative medical expense of basic medical insurance for residents is 200,000 yuan. If insured residents have paid continuously for 5 years or more, the maximum annual cumulative medical expenses will be increased by 50,000 yuan; the resident medical insurance fund will no longer pay for the portion above the maximum annual cumulative medical expenses. ◆The medical expenses for outpatient treatment of special diseases are 90%, and the expenses are combined with ordinary inpatient medical expenses to calculate the annual maximum limit. (3) Wuxi Resident Basic Medical Insurance medical treatment and reimbursement process: 1. First, the insured patient takes his or her "Resident Medical Insurance Medical Record" and "Social Security Card" to the individual agreed service center for medical treatment (children under 3 years old can go directly to Medical institutions with pediatric diagnosis and treatment subjects designated by the Personal Appointment Service Center); 2. If the existing medical technology cannot provide services, the person or his family member should go to the Personal Appointment Service Center with the above card to handle the referral procedures (valid for three days) , transfer to a designated medical institution in the urban area that has the designated qualification for employee basic medical insurance; 3. If insured residents encounter emergencies in this city or other places (within the country), they can go to the nearest medical institution for medical treatment; 4. Emergency (need to comply with the " Jiangsu Provincial Diagnostic Standards for Emergency and Critical Illnesses") and unmarked medical expenses shall be reimbursed at the community health service center agreed upon by the insured.

3. Contents not covered by medical insurance: The social medical insurance fund will not pay for the medical expenses incurred by the insured under the following circumstances: (1) Except for emergencies, medical expenses incurred by the insured without approval and relevant procedures have been completed. Expenses incurred for medical treatment outside the designated service centers agreed upon by individuals; (2) Expenses incurred during the period when insured residents interrupt payment; (3) Expenses outside the urban residents’ medical insurance drug catalog and diagnostic and treatment service items and facility scope standards; (4) Plastic surgery , Cosmetic surgery; (5) Childbirth expenses; (6) Going abroad or during travel; (7) Medical expenses incurred due to crime, fighting, fighting, alcoholism, drug abuse, suicide, self-injury; (8) Deliberate violations, traffic accidents , medical accident; (9) Medical expenses incurred in other situations that violate laws and regulations; (10) Other medical expenses that do not meet the payment scope of social medical insurance.

IV. Medical treatment in other places (1) Settlement of medical treatment in other places in Jiangsu Province. People from other places seek medical treatment in Wuxi: 1. Insured persons from other places must first go to the insured place to apply and fill out the "Application for Medical Treatment in Other Places by Insured Persons" Form", successful registration; 2. With the stamped and confirmed "Application Form" and ID card, go to Wuxi to apply for a local social security card, and then go to the designated hospital in Wuxi to swipe the card for settlement. (2) Wuxi insured persons seek medical treatment in other places in other areas of Jiangsu Province: 1. Insured persons who live in other places for a long time (more than 6 months) can apply for medical treatment in other places; 2. Fill out the "Application Form for Medical Treatment in Other Places for Insured Persons" and seek medical treatment in other places. Select three public medical institutions of different levels in the local area as the designated medical institutions for medical treatment; 3. If you want to choose to enjoy the outpatient coordination treatment, you should choose a community health service institution as the designated first medical institution under the same conditions; 4. Registration procedures should be carried out at various offices of the Wuxi Social Security Center; 5. After successful registration, go to the medical insurance agency at the place of treatment to complete the transfer procedures; 6. Medical expenses incurred in the current year shall be settled by the end of June of the following year, and no reimbursement will be made after the expiration date.

5. Critical illness insurance benefits for urban and rural residents (1) Eligible objects: Participants of the city’s basic medical insurance for urban residents and basic medical insurance for urban employees. (2) Scope of coverage: Critical illness medical insurance does not distinguish between types of diseases. Compliant medical expenses for inpatient and outpatient treatment of special diseases can be included in the reimbursement. (3) What are the situations in which serious illness medical insurance cannot reimburse? What is not included in the city’s social medical insurance settlement system does not fall within the scope of serious illness medical insurance, including medical expenses for work-related injury and maternity insurance. (4) Reimbursement ratio and standard: The actual payment ratio of critical illness insurance is not less than 50%, as follows: ◆If the personal burden is between 10,000 yuan and 50,000 yuan (including 50,000 yuan), 50% will be subsidized; ◆Personal burden If the amount is between 50,000 yuan and 100,000 yuan (including 100,000 yuan), 60% will be subsidized; ◆If the personal burden is more than 100,000 yuan, 80% will be subsidized; ◆The minimum payment line for serious illness medical insurance is 10,000 yuan , there is no cap on the subsidy amount.

◆In addition, Xicheng will adjust and introduce new minimum payment standards every two years based on the annual per capita disposable income of urban residents in the previous year. I have compiled the information on these issues here, hoping it will be helpful to you. Our country's laws are gradually improving, and we also look forward to helping more people.