According to my knowledge, the medical insurance policy in Nanjing is still quite open and transparent in general. If there is an opportunity, I recommend you to search the implementation methods of social medical insurance in Nanjing. According to the relevant provisions of the implementation measures of this method, in Nanjing, the personnel who participate in the basic medical insurance for urban workers are classified as personal accounts except for a part of 2% paid by individuals, and the staff over 35 years old are classified as 1% of their own contribution base, and those over 35 years old to 45 years old are classified as 1.4% of their personal social security contribution base; From the age of 45 to retirement, it is classified according to 1.7% of its own deposit base; Retired workers are classified according to 5.4% of their pension last month, and there is a moral bottom line for setting the authority, that is, less than 5 yuan per month is added to 5 yuan. With the increase of age, the minimum amount will continue to grow, but the 5 yuan here includes the medical assistance fee for serious illness that must be paid by themselves, which is to pay 1 yuan every month.

If it belongs to on-the-job employees, the medical assistance fee for serious illness is included in the monthly deposit ratio. In addition, there are several types of medical insurance in Nanjing that need to be deducted, such as medical insurance for migrant workers with serious illness and mutual medical insurance for migrant workers with serious illness. Anyone who participates in medical insurance for migrant workers' serious illness should also participate in mutual medical insurance for migrant workers' serious illness. Medical insurance for migrant workers' serious illness is paid by the unit, but I have to pay mutual medical insurance for migrant workers' serious illness, and the monthly payment amount is 4 yuan.

If you are a retired worker, the medical security system in Nanjing includes three new items: social medical insurance, medical assistance for serious illness and critical illness insurance. Retired workers must deduct 1 yuan from their personal accounts every month as medical aid for serious illness, and at the same time, the medical insurance fund also needs to transfer a part as critical illness insurance expenses. What role does medical assistance for serious illness cost? The key is to deal with the problem of medical insurance reimbursement above the standard of medical insurance reimbursement amount. For example, in a natural year, 9% of the maximum payment limit of the pooling fund is paid by the urban and rural residents' serious illness pooling stock fund for the part below 15, yuan; More than 15, yuan will be paid according to the proportion of 95%. This is the second expense reimbursement.

In addition, Nanjing Medical also has the third expense reimbursement, which is the critical illness insurance jointly launched by Nanjing and commercial insurance companies. Critical illness insurance and medical assistance for serious illness are different. People who only need to participate in the medical insurance for employees and urban medical insurance for critical illness insurance do not need this diplomatic fee, but are transferred and paid social security by medical insurance funds. In a natural year, the medical expenses for medical insurance hospitalization of employees and special new projects in hospital outpatient service, hospitalization of urban residents and serious illness in outpatient service within the scope of social medical insurance payment, under the premise of enjoying basic medical insurance benefits, I will pay the part beyond the deductible line of critical illness insurance at my own expense, and the critical illness insurance will pay in accordance with the regulations.

at present, the deductible line stipulated by Nanjing is 5% of the per capita income of urban residents in the previous year, of which 6% is paid for the employee's serious illness insurance, which is more than 4, yuan above the deductible line; 65% of the payment is from 4, yuan to 6, yuan; 7% of the payment is from 6, yuan to 8, yuan; 75% of the payment is from 8, yuan to 1, yuan; More than 1, yuan will be paid 8% in part. Residents' serious illness insurance, 5% of the payment above the deductible line to more than 4, yuan; 55% of the payment is from 4, yuan to 6, yuan; 6% of 6, yuan to 8, yuan; 65% of the payment is from 8, yuan to 1, yuan; More than 1, yuan will be paid in part by 7%.

For example, when you were hospitalized, you spent more than 1, yuan on medical expenses, basically more than 5, yuan for reimbursement of cooperative medical care, and 5, yuan had to be paid out of pocket, and the deductible line was 2, yuan. Those who exceeded 2, yuan could be reimbursed by medical insurance for serious illness. According to the relevant regulations of Nanjing, some of them paid more than 5, yuan, and some of them paid more than 2, yuan also had more than 3, yuan. The proportion of medical insurance reimbursement for employees was 6%

Generally speaking, 1 yuan or 2 yuan is deducted from the personal medical insurance account in Nanjing every month. If you are a retired employee, it is very likely that the expenses for serious illness relief in Nanjing will be deducted. If you belong to on-the-job employees, there will be no diplomatic problem of serious illness insurance, which is included in the monthly pension insurance expenses. Migrant workers pay 4 yuan mutual aid fund for serious illness, because migrant workers do not have personal accounts, so there will be no problem of deduction in personal accounts. I don't understand that it is best to consult the medical insurance department in the social security insurance area.