The medical assistance expenses are as follows:
(1) The deductible line is 8,000 yuan: excluding personal expenses below the deductible line of basic medical insurance, it should include civil subsidies and medical assistance for poor patients, and the personal burden of low-income households, special care recipients and rural five-guarantee households below the deductible line standard of basic medical insurance reimbursement for serious illness should be included in the deductible line standard. The deductible of 8000 yuan is an annual deductible, which can only be deducted once a year. (2) The compensation standard adopts the method of "subsection proportion, from low to high, and progressive compensation": subsection proportion is 50%, 60%, and 70%, of which: 50% is paid for 8,000 yuan to 30,000 yuan (inclusive), 60% is paid for 30,000 yuan to 50,000 yuan (inclusive), and 70% is paid for more than 50,000 yuan.
(3) Not included in the reimbursement scope of serious illness insurance: Medical expenses incurred in non-designated medical institutions in the province and non-public hospitals outside the province are not included in the reimbursement scope of serious illness insurance. The medical expenses incurred in the abnormal referral of medical institutions in the province and in public hospitals outside the province shall be included in the calculation of serious illness insurance self-sufficiency and compliance medical expenses according to the proportion of 60% after the basic medical insurance is reimbursed according to relevant policies.
(4) Maximum reimbursement amount of serious illness insurance: The maximum annual payment amount of serious illness insurance is 500,000 yuan per person per year. (5) Accidental injuries and traffic accidents that are not the responsibility of a third party, the out-of-pocket expenses of the insured residents are fully included in the coverage of serious illness insurance after being compensated by the basic medical insurance fund, and the expenses of implanting large materials in the body within 30,000 yuan after being compensated by the basic medical insurance fund are fully included in the coverage of serious illness insurance, and the part exceeding 30,000 yuan will not be compensated.
The above-mentioned compliance expenses of insured urban residents are included in the scope of serious illness insurance according to the existing relevant policies.
How much is medical assistance generally?
1, urban residents, destitute dependents, model workers of low-income families at or above the municipal level for hospitalization, outpatient treatment for serious diseases or serious chronic diseases, and the maximum amount of accumulated assistance per person per year for hospitalization for other diseases is 40,000 yuan, and the maximum amount of assistance per person per year is 30,000 yuan.
2. After obtaining all kinds of insurance compensation and special medical assistance, the non-subsistence allowance for hospitalization or outpatient treatment of serious diseases or serious chronic diseases shall be paid at 60% of the total disposable income of the family in that year (disposable income refers to the total household income in that year-* * * the number of family members living together × minimum living standard × 12 months, the same below).
How much is medical assistance generally?
First, hospitalization assistance:
The medical assistance for the first category of recipients is calculated in a progressive way: if the individual's own expenses do not exceed 1 10,000 yuan (including 1 10,000 yuan), 70% of the part from 1 10,000 yuan to 20,000 yuan (including 20,000 yuan) will be assisted, and 75% and 80% of the part above 20,000 yuan will be assisted. Give full assistance to the second kind of destitute dependents at their own expense.
(a) for various reasons failed to participate in urban and rural basic medical insurance relief object, according to 30% of the medical expenses to be rescued, the annual maximum relief 10000 yuan.
(2) If an individual is hospitalized due to accidental injury without the third responsible party, he/she will be given assistance at his/her own expense at the rate of 30%, with the maximum annual assistance of 1 1,000 yuan.
(3) For those who seek medical treatment in non-profit medical institutions outside the province, non-designated medical institutions in the province, medical institutions below the second level outside the province and for-profit medical institutions, the individual shall be given self-funded assistance at the rate of 30%, with the maximum annual assistance of 1 000 yuan.
Three or four kinds of hospitalization, according to the following standards to give assistance (including the fourth kind of annual maximum assistance of 6.5438+0 million yuan):
(1) If the annual personal expenses exceed 30,000 yuan but less than 50,000 yuan, the annual capping line standard for medical assistance is 5,000 yuan.
(2) If the annual personal expenses are more than 50,000 yuan and less than 6,543,800 yuan, the maximum annual medical assistance standard is 6,543,800 yuan.
(3) If the annual personal expenses exceed 654.38+10,000 yuan, the annual medical assistance ceiling standard is 25,000 yuan.