1, general outpatient fee settlement
In an insurance year, the medical expenses of residents' medical insurance general outpatient service are more than 1000 yuan in 200 yuan, and the residents' medical insurance fund pays 50% (that is, 400 yuan); /kloc-expenses above 0/000 yuan shall be borne by the individual.
2, outpatient critical settlement
Insured residents hold medical insurance cards to treat serious (chronic) diseases in designated hospitals, which is in line with the medical expenses paid by residents' medical insurance fund. Item 1 of Class B 10%, where materials, artificial organs and blood products are placed in the body, the fund pays 35% and the individual pays 65%. The remaining part of the residents' medical insurance fund pays 50% and the individual pays 50%.
3. Settlement of hospitalization expenses
(1) hospitalization Qifubiaozhun: community, first-class hospital 200 yuan, second-class hospital 400 yuan, third-class hospital 800 yuan. In an insurance year, if the insured residents are hospitalized for more than two times, the Qifubiaozhun will be halved (except for community and first-class hospitals); The insured residents referred to the higher-level hospitals should make up the difference between the medical insurance fund qifubiaozhun (there is no qifubiaozhun for the disabled who enjoy the minimum living allowance).
(2) below the individual pays qifubiaozhun; Qifubiaozhun above and in line with the hospitalization expenses paid by residents' medical insurance fund, the proportion paid by residents' medical insurance fund is: 80% paid by community, first-class hospital and Huimin hospital fund; The secondary hospital fund pays 70%; Third-level hospital fund pays 60% (for disabled people who enjoy subsistence allowances, the proportion of fund payment is increased by 2% on the current standard);
(3) For hospitalization in designated hospitals at different levels, Class A shall be paid according to the above proportion; Class B individuals pay 10% first, the remaining funds pay 60%, and individuals pay 40%; The fund pays 35% for placing materials in the body and replacing artificial organs and blood products, and the individual pays 65%.
4, outpatient emergency hospitalization expenses settlement
If the insured residents are hospitalized immediately after emergency treatment in outpatient clinic due to critical, acute and serious diseases, the emergency rescue expenses shall be incorporated into the hospitalization expenses.
5, residents' medical insurance maternity settlement
Residents' medical insurance conforms to the requirements of the national family planning policy, and the medical expenses of outpatient prenatal examination and general outpatient medical expenses are calculated together, that is, 400 yuan is reimbursed. In line with the provisions of the national family planning policy, the medical expenses of hospital delivery (natural delivery, midwifery and cesarean section) shall be paid by the residents' medical insurance fund according to the highest 700 yuan/time standard.
Extended data
Security object
1. All urban residents who have urban household registration in Wuhan and are not included in the basic medical insurance system for urban workers can participate in residents' medical insurance. Specific objectives include:
Students, children and other residents under the age of 18 in all kinds of primary and secondary schools (including vocational high schools, technical secondary schools and technical schools, the same below); /kloc-Non-employed residents aged 0/8 and above; Elderly people aged 60 and above who do not enjoy pension or pension benefits on a monthly basis (hereinafter referred to as elderly people from low-income families).
2. Non-urban household registration, students who have attended all kinds of primary and secondary schools (including vocational high schools, technical secondary schools and technical schools) in this city and obtained the status of students in this city.
3. Land-expropriated farmers in the urban planning area.
4. Non-employees who are not registered in cities and towns and have lived in this city for a long time. Persons who have participated in employee medical insurance, new rural cooperative medical care and other medical insurance organized by the government according to regulations cannot participate in residents' medical insurance.
References:
Wuhan Municipal People's Government-Municipal People's Government on Printing and Distributing Basic Medical Care for Urban and Rural Residents in Wuhan