The reimbursement deductible line for large medical insurance increases year by year. The deductible line for reimbursement will be adjusted in a timely manner according to the increase of employees' social wages and the affordability of large medical insurance funds.

large medical insurance refers to solving the medical expenses incurred by the insured due to serious illness and serious illness that exceed the maximum payment limit of the basic medical insurance pooling fund. On the basis of the basic medical insurance, the municipal medical insurance has established a large medical insurance system.

Reimbursement of large medical insurance:

After the insured's hospitalization medical expenses exceed the maximum payment limit of the basic medical insurance pooling fund, the unit or hospital shall fill in the Declaration Form of Large Medical Pooling Expenses and report it to medical insurance bureau.

In case of medical treatment, except for the part paid by the individual, the large medical expenses shall be settled by the hospital and medical insurance bureau; Transferred for medical treatment, by the unit with the "medical declaration form", the receipt of hospitalization expenses, discharge summary, expense list to the city of medical insurance bureau for reimbursement.

the reimbursement rate for large medical expenses is 9% (8% for those transferred to other hospitals), and the maximum payment limit of large medical insurance fund within 12 months is 125, yuan (excluding 25, yuan paid by the basic medical insurance pooling fund).

reimbursement standard of large medical insurance:

after the insured person enters the large medical insurance payment, the medical expenses for emergency rescue in hospital and outpatient service and treatment of serious diseases and chronic diseases in outpatient service that meet the requirements of basic medical insurance will be accumulated by the large medical insurance fund and the insured person in proportion, and will be shared by * * *.

The specific criteria are as follows:

(1) 94% of the portion from 45, yuan to 1, yuan (including 1, yuan) is paid by the large medical insurance fund, and 6% is paid by the insured; From 1, yuan to 2, yuan (including 2, yuan), the large medical insurance fund pays 96%, and the insured pays 4%; For the part of more than 2, yuan, 98% is paid by the large medical insurance fund, and 2% is paid by the insured.

(2) The medical expenses for the insured to use the medical treatment items paid by the basic medical insurance pooling fund and the Class B drugs in the Catalogue of Drugs for Basic Medical Insurance shall be paid by the individual at first, and the medical expenses for the approved use of blood shall be paid by the individual at first, and the balance shall be borne by the large medical insurance and the insured in proportion according to the regulations.

(3) The insured uses the artificial organ replacement and implant materials that meet the requirements of the basic medical insurance, of which 35% is paid by the individual and 65% is paid by the large medical insurance; If it is imported, the individual pays 5% and the large medical insurance pays 5%.

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