1. Insured employees must present their citizen card and swipe the card for outpatient and inpatient treatment. The outpatient clinic must inform the hospital of the type of treatment (such as outpatient chronic disease, special care). If the card is not produced or the type of treatment is unclear, insured employees must seek medical treatment.

The medical insurance fund will not pay for medical expenses incurred during the period.

2. When purchasing medicines at designated retail pharmacies, insured persons must present their citizen card, inform the type of treatment (such as outpatient chronic disease, special care), and swipe the card to purchase medicines in accordance with relevant policies. When others purchase medicines on their behalf due to special circumstances, they must present their insured card.

The ID cards of the personnel and purchasing agents shall be registered and filed by the pharmacy.

3. Outpatient coordination implements a first-diagnosis and referral system based on community health service institutions.

Insured persons can have their first consultation at designated community health service institutions of the Urban Employee Basic Medical Insurance or medical institutions that refer to community management; specialized hospitals can be used as first consultation medical institutions for all insured persons.

If the insured person needs to be referred, the first medical institution will be responsible for the referral. Emergency treatment and rescue are not subject to this restriction.

4. After the outpatient chronic disease subsidy limit is used up, you will directly enjoy the outpatient overall treatment from the next payment. No referral is required for chronic disease treatment at the original outpatient clinic.

After the subsidy limit for specific outpatient items is used up, the referral procedures must be completed in accordance with the regulations of outpatient coordination and general medical records must be used before you can enjoy the benefits of outpatient coordination.

Buying medicines in pharmacies does not enjoy the outpatient coordination treatment.

5. The reimbursement ratio of employee medical insurance. The reimbursement ratio of employee medical insurance in tertiary hospitals is: for medical expenses with a minimum payment standard of 30,000 yuan, the basic medical insurance pooling fund pays 85% and the individual employee pays 15%;

For the portion of 30,000 to 40,000 yuan, the basic medical insurance overall fund can pay 90%, and individual employees need to pay 10%; for medical expenses exceeding 40,000 yuan, the overall fund can pay 95%, and individual employees must pay 5%.

6. The reimbursement ratio of employee medical insurance in secondary hospitals is: for the part from the minimum payment standard to 30,000 yuan, the overall fund payment can reach 87%, and the employee's personal payment can reach 13%; when the reimbursement exceeds 30,000 yuan to 40,000 yuan

For medical expenses, 92% is paid by the overall fund and 8% is paid by individual employees; for the part exceeding 40,000 yuan, the basic medical insurance overall fund pays up to 97%, while individual employees pay only 3%.

7. The reimbursement ratio of employee medical insurance in first-level hospitals and home beds is: for the part from the minimum payment standard to 30,000 yuan, the basic medical insurance pooling fund pays 90%, and the employee pays 10% individually; for the part exceeding 30,000 yuan or even

For the portion of 40,000 yuan, the overall fund payment can reach as high as 95%, and individual employees pay only 5%; for the portion exceeding 40,000 yuan, the basic medical insurance overall fund pays 97%, and individual employees pay 3%.

8. The personal payment ratio of retirees only accounts for 60% of the employee payment ratio.

If the payment ratio of the basic medical insurance pooling fund in Paragraph 1 needs to be adjusted, the municipal labor and social security administrative department must jointly propose an adjustment plan with the municipal financial department, and submit it to the municipal people's government for approval before it is announced and implemented.