First, general outpatient service.
1. Reimbursement ratio: 50% is paid by the residents' medical insurance fund.
2. Reimbursement amount: annual payment limit of 400 yuan.
3. Qifubiaozhun: Residents have no Qifubiaozhun in community health service centers (no medical grade), township health centers, community health service stations and village clinics; Other medical institutions outpatient Qifubiaozhun accumulated 200 yuan throughout the year.
Note: The medical expenses for prenatal check-up in outpatient clinics that meet the requirements of fertility are calculated together with those in general outpatient clinics, and the relevant provisions of general outpatient clinics are implemented.
Two, hypertension, diabetes outpatient medication security
1. Reimbursement ratio: 50% shall be paid by the overall fund.
2. Reimbursement amount: the maximum monthly payment limit for hypertension is 30 yuan; The maximum monthly payment limit for diabetes is 40 yuan; The monthly payment limit for "two diseases" is 50 yuan.
III. Outpatient treatment of severe (chronic) diseases
1, reimbursement ratio: the basic medical insurance fund pays 50%; The proportion of phenylketonuria compensation is 70%.
2. Reimbursement amount: the annual payment limit of the basic medical insurance fund is 4,000 yuan to10.5 million yuan. Insured persons who have undergone radiotherapy and chemotherapy for malignant tumors (including leukemia), chronic renal failure requiring renal dialysis treatment, anti-rejection after kidney transplantation and anti-rejection after liver transplantation can pay a maximum of 300,000 yuan.
Fourth, hospitalization.
Hospital level
Pay line standard
Payment proportion
First hospitalization
Second and above hospitalization
Tertiary medical institutions
Eight hundred yuan
400 yuan
60%
Secondary medical institutions
400 yuan
Two hundred yuan
70%
First-class medical institutions (if the level of community health service center is higher than the first level, the first-class standard shall be implemented)
Two hundred yuan
Two hundred yuan
90%
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The medical expenses incurred by using Class B drugs and Class B diagnosis and treatment projects shall be paid by the individual first10%; The hospitalization expenses incurred by medical treatment in different places are paid by the individual10%; The use of special drugs, in accordance with the relevant laws and regulations of medical insurance payment standards and the proportion of the first self-payment, and then according to the relevant laws and regulations of the payment management of Class B drugs.
note:
1, transfer between designated medical institutions (departments) is regarded as a hospitalization, and the Qifubiaozhun of high-level medical institutions is implemented, and the payment ratio of transfer and transfer to medical institutions is implemented respectively.
2, in accordance with the provisions of the maternity hospital delivery medical expenses, paid by the residents' medical insurance fund according to the highest standard 700 yuan/times.
3, in the outpatient emergency rescue after hospitalization, the emergency rescue expenses included in the hospitalization expenses.
4. In an insurance year, the maximum payment limit of basic medical insurance is 6.5438+0.5 million yuan.
Verb (abbreviation of verb) critical illness insurance
1. Reimbursement ratio: within an insurance year, the amount of personal burden that meets the coverage of serious illness insurance is calculated cumulatively, reimbursed by stages and settled by time.
Cumulative amount
Compensation ratio
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More than 10,000 yuan and less than 30,000 yuan
60%
The annual maximum payment limit is 300,000 yuan. In an insurance year, each insured patient only deducts the minimum payment for critical illness insurance once.
More than 30,000 yuan and less than 654.38+10,000 yuan.
65%
More than 654.38+ten thousand yuan
75%
2. Qifubiaozhun: the personal burden that meets the coverage of serious illness insurance 10000 yuan. The above part of Qifubiaozhun shall be reimbursed by serious illness insurance in proportion.