2. Hospitalization medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), the "self-pay one" part of the expenses borne by the employees is deducted for the first hospitalization 1.300 yuan (650 yuan is deducted for the second hospitalization; 650 yuan was deducted for the first hospitalization of poor workers, and 325 yuan was deducted for the second hospitalization. After the deductible, the mutual aid is calculated at 20% (25% for model workers and poor workers).
3. Outpatient and inpatient medical expenses above the capping line: Out-of-pocket expenses that still occur within the scope of medical insurance after the "self-paying one" expenses of outpatient and inpatient employees reach the capping line of basic medical insurance can enjoy 40% of the mutual aid fund from the capping line to 50,000 yuan, with the maximum reimbursement amount of 20,000 yuan; 50,000 yuan to 654.38+million yuan, you can enjoy 60% mutual aid, and the maximum reimbursement amount is 30,000 yuan; 100000 yuan to 150000 yuan, you can enjoy 80% mutual aid, and the maximum reimbursement amount is 40000 yuan.
Reimbursement scope of trade union medical mutual assistance
1. Outpatient medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), after deducting the deductible line 1800 yuan from the "self-pay one" part, it will be 20% (25% for model workers and extremely poor employees).
2. Hospitalization medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), the "self-pay one" part of the expenses borne by the employees is deducted for the first hospitalization 1.300 yuan (650 yuan is deducted for the second hospitalization; 650 yuan was deducted for the first hospitalization of poor workers, and 325 yuan was deducted for the second hospitalization. After the deductible, the mutual aid is calculated at 20% (25% for model workers and poor workers).
3. Outpatient and inpatient medical expenses above the capping line: Out-of-pocket expenses that still occur within the scope of medical insurance after the "self-paying one" expenses of outpatient and inpatient employees reach the capping line of basic medical insurance can enjoy 40% of the mutual aid fund from the capping line to 50,000 yuan, with the maximum reimbursement amount of 20,000 yuan; 50,000 yuan to 654.38+million yuan, you can enjoy 60% mutual aid, and the maximum reimbursement amount is 30,000 yuan; 100000 yuan to 150000 yuan, you can enjoy 80% mutual aid, and the maximum reimbursement amount is 40000 yuan.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.