1, the insured employees will enjoy the treatment of overall payment from the month following the insured payment (including renewal); Flexible employees who participate in employee medical insurance for the first time (including those transferred from outside the overall planning area) will enjoy the treatment of overall planning payment from the seventh month of insurance payment.

2, the insured workers general outpatient medical expenses, paid by personal account funds.

3, the insured workers suffering from chronic diseases and meet the standards, can apply for outpatient medical treatment of chronic diseases, enjoy outpatient expenses reimbursement treatment. In a settlement year, 80% of the outpatient expenses that meet the requirements will be paid by the overall fund over 600 yuan (90% will be paid for dialysis and anti-rejection treatment).

4. The medical expenses incurred by the insured workers for extracorporeal shock wave lithotripsy of urinary calculi and chemotherapy, radiotherapy or review of malignant tumors in the outpatient department of the designated medical institution in the insured place shall be included in the payment scope of the overall fund, and 90% of the medical expenses that meet the requirements within the limit standard shall be paid by the overall fund.

5. Hospitalization

(1) Qifubiaozhun: 200 yuan, a first-class and below medical institution, 500 yuan, a second-class medical institution, 900 yuan, a third-class comprehensive medical institution, 1.200 yuan, transfer from outside the city 1.800 yuan.

Hospitalization for malignant tumor, mental illness and other diseases and two-way referral hospitalization can appropriately reduce the hospitalization qifubiaozhun.

(2) Reimbursement ratio: hospitalization in designated medical institutions in the overall planning area meets the prescribed medical expenses, and the medical insurance pooling fund pays 92% (regardless of items A and B, the same below); Secondary medical institutions pay 90%; Tertiary medical institutions pay 82%. For those who have gone through the registration and filing of residence in different places, referral procedures outside the city, temporary first aid, and reported to the medical insurance agency for registration and filing, 75% of the hospitalization expenses that meet the requirements (70% of the payment for transfer outside the province) are paid, and 60% of the medical institutions outside the insured place have not gone through the referral and filing procedures.

6, the insured workers sudden illness in outpatient emergency rescue, the outpatient emergency rescue expenses included in the hospitalization expenses to be reimbursed. If the patient dies after emergency rescue, the outpatient emergency rescue expenses shall be reimbursed according to the relevant treatment of hospitalization.

7, the insured workers in the designated medical institutions for rehabilitation, the rehabilitation medical expenses shall be paid on a daily basis.

8. If the insured workers are hospitalized in local designated medical institutions for a long time due to mental illness, the hospitalization expenses shall be paid daily after 60 days.

9. For women who participate in medical insurance for flexible employees, the hospitalization and maternity medical expenses in line with the national fertility policy shall be subsidized by a fixed amount, with a maximum subsidy of 2,500 yuan within the scope of the medical insurance policy.

10. The accidental injury insurance premium is raised from the employee medical insurance pooling fund to pay the hospitalization expenses of the insured employees due to accidental injuries.

1 1. In a settlement year, the accumulated maximum payment limit of employee medical insurance fund is 200,000 yuan.

12, employee critical illness insurance

Insured employees in a settlement year as a whole fund payment costs accumulated more than the basic medical insurance payment capping line, by the employee's serious illness insurance fund according to the employee's medical insurance Qifubiaozhun, reimbursement ratio and other related treatment policies to continue reimbursement; If the insured employees' out-of-pocket expenses (excluding the out-of-pocket expenses of the self-pay line and chronic disease outpatient service) meet the requirements within a settlement year, the employee's serious illness insurance fund will give appropriate subsidies. The annual cumulative maximum payment limit of the employee's serious illness insurance fund is 350,000 yuan. The specific measures shall be formulated by the Municipal Human Resources and Social Security Bureau.

note:

1, the following medical expenses are not included in the payment scope of employee medical insurance fund.

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

2, the insured workers in designated medical institutions for medical treatment according to the principle of graded diagnosis and treatment. When seeking medical treatment, you must take the initiative to show valid certificates such as medical insurance cards, and all designated medical institutions check the identity of medical insurance patients. If it is necessary to transfer to a higher medical institution for medical treatment due to illness, it shall go through the referral procedures.

3, the insured workers living in the field for a long time, or in the field of sudden illness must be hospitalized in the emergency, in the medical insurance agencies to handle the corresponding registration procedures.

4, the insured workers in the local designated institutions and remote networking institutions for medical treatment, the implementation of online real-time settlement. For medical treatment in other institutions, the individual shall pay the medical expenses in advance, and apply for reimbursement to the medical insurance agency in the insured place with relevant information.