Article 29 The service scope and payment standards of medical insurance shall be implemented in accordance with the national and provincial basic medical insurance drug catalogs, diagnosis and treatment items, medical service facility scope standards and corresponding management measures.

Article 30 Employers and employees should participate in medical insurance in accordance with regulations and continuously pay medical insurance premiums in full.

If the medical insurance premium is not paid in full and on time, the insured employees will be stopped from enjoying medical insurance benefits; if the payment is overdue, the medical expenses incurred during the make-up period will not be entitled to medical insurance benefits.

Article 31 The outpatient medical expenses incurred by insured employees suffering from outpatient chronic diseases shall be included in the payment scope of the overall fund.

The specific implementation shall be in accordance with the relevant regulations of our city.

Article 32 The stipulated hospitalization medical expenses incurred by insured employees in designated medical institutions shall be included in the payment scope of the overall planning fund, and shall be implemented in accordance with the following regulations: (1) For hospitalization in a third-level hospital, the minimum payment standard of the overall planning fund shall be:

700 yuan, and 600 yuan for retirees; for the excess, employees will bear 20% and retirees will bear 15%.

(2) For hospitalization in a secondary hospital, the minimum payment standard of the overall fund is: 600 yuan for employees and 500 yuan for retirees; for the excess, employees will bear 15% and retirees will bear 10%.

(3) For hospitalization in first-level hospitals and other types of medical institutions, the minimum payment standard of the overall fund is: 500 yuan for employees and 400 yuan for retirees; for the excess, employees will bear 10% and retirees will bear 5%.

There is no minimum payment standard starting from the third hospitalization within a medical year, and the payment amount of the overall fund is determined according to the hospital grade and burden ratio.

Article 33: The annual maximum payment limit system shall be implemented for medical insurance pooling fund payment.

The maximum payment limit of the medical insurance pooling fund for insured employees within a medical year is 300,000 yuan.

Among them, the basic medical insurance pooling fund can pay up to 100,000 yuan, and the large medical insurance pooling fund can pay up to 200,000 yuan.

The maximum payment limit of the basic medical insurance pooling fund and the large-amount medical insurance pooling fund shall be adjusted in a timely manner by the municipal human resources and social security department in conjunction with the municipal finance department.

Article 34 If a person participating in large-amount medical insurance falls ill and the medical expenses exceed the maximum payment limit of the basic medical insurance pooling fund and are within the payment range of the pooling fund, the insured employee shall bear 15% of the personal burden, and the large-amount medical insurance fund will pay 85%

%.

Article 35 For those who participate in the civil servant medical subsidy, if the outpatient chronic disease outpatient expenses and hospitalization expenses paid by the individual within the payment scope of the basic medical insurance and large-amount medical insurance exceed 10% of the individual's annual payment base, the civil servant medical subsidy funds shall be paid according to the amount.

90% are subsidized.

Article 36 The medical expenses incurred by insured employees that are within the scope of payment of the overall fund for "Class B drugs" or "Class B diagnosis and treatment items" shall be borne by the individual 10%, and then the medical expenses shall be paid according to the proportion stipulated in Article 32 of these regulations.

The overall fund and individuals are paid separately.

Article 37 The payment standard for inpatient bed fees shall be determined according to the standard for general inpatient ward bed fees stipulated by the price department.

If the insured employee's actual bed fee is lower than the basic medical insurance hospitalization bed fee payment standard, the actual bed fee will be paid; if it is higher than the payment standard, the excess portion will be borne by the insured employee.

Article 38 If the hospitalization bed fee for patients who need to be isolated or critically ill exceeds the basic medical insurance hospitalization bed fee payment standard, the insured employees will bear 30%, and then the proportion stipulated in Article 32 of these regulations will be paid by the overall fund and

Pay individually.

Article 39 If an insured employee really needs to be transferred to an out-of-city hospital for treatment due to illness, he or she must report to the medical insurance agency for approval.

If hospitalization medical expenses meet the scope of the city's basic medical insurance medication, diagnosis and treatment items, and medical service facility standards, the personal burden ratio will be increased by 5 percentage points based on the ratio stipulated in Article 32 of these regulations.

If the condition is critical, the patient can be transferred to another hospital first, and the approval procedures must be completed within 3 working days from the date of transfer.

Article 40 If an insured employee is hospitalized due to an emergency in a non-designated medical institution while away on business, on statutory leave, or visiting relatives, he or she shall notify the medical insurance agency in the insured place for registration within 3 working days after hospitalization.

If the situation is verified to be true and the hospitalization medical expenses are within the scope of the city's basic medical insurance medication, diagnosis and treatment items, and medical service facility standards, the personal burden proportion shall be in accordance with the proportion stipulated in Article 32 of these regulations.

Article 41: Retirees and employees of units stationed abroad who have lived outside the city for a long time are subject to a registration and filing system for people in other places, and can choose no more than three medical insurance designated medical institutions in their place of residence for medical treatment.

Article 42 Anyone who has any of the following circumstances will not enjoy medical insurance benefits: (1) Going to non-designated medical institutions for treatment without the approval of the medical insurance agency (except for emergency rescue); (2) Occupational diseases, childbirth of female employees

, Injury due to work or relapse of old work-related injury; (3) Injury caused by illegal crime, alcoholism, suicide, self-mutilation, or accidental injury by a responsible person; (4) Injury caused by traffic accident, medical accident, pharmaceutical accident; (5) Injury caused by traffic accident, medical accident, pharmaceutical accident;

) for corrective treatment of congenital disabilities; (6) for medical treatment while traveling abroad, visiting relatives, inspections, further studies, and giving lectures in Hong Kong, Macao, and Taiwan; (7) other situations in which medical insurance is not applicable according to national and provincial regulations.