1, outpatient reimbursement There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. Within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan.

2. The proportion of hospitalization reimbursement The longer the continuous insurance period, the greater the proportion of reimbursement. The proportion of hospitalization reimbursement of the medical insurance fund will increase by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative amount will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

College students' medical insurance reimbursement scope:

1. There is no disease limitation for hospitalization reimbursement. College students must pay a certain deposit to pay the expenses that need to be borne by individuals, and refund more and make up less when checking out. College students' medical insurance is temporarily kept by the hospital medical insurance office during hospitalization. After the discharge formalities are completed, the hospital medical insurance office is responsible for filling in the overall payment form on the homepage of college students' medical insurance as required, and returning the college students' medical insurance to me.

2. Maternity expenses shall be subsidized in a fixed amount. The quota standard is: normal delivery in 800 yuan, cesarean section 1600 yuan. If the birth cost is lower than the limit standard, the subsidy shall be given according to the actual expenditure; Higher than the quota standard, according to the quota standard subsidies.

3. The range of chronic diseases includes: coronary atherosclerotic heart disease (excluding occult type), chronic pulmonary heart disease, essential hypertension (above phase II), cerebrovascular disease in recovery period, decompensated cirrhosis, diabetes complicated with chronic complications, chronic glomerulonephritis and nephrotic syndrome, advanced malignant tumor, psychosis, lupus erythematosus and Parkinson's syndrome1kloc-0/disease. Payment standard: outpatient chronic disease treatment will be settled annually. Within a year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed those in 350 yuan, the excess shall be paid by the overall fund and individual by 50%. In a year, the maximum amount of outpatient chronic disease medical expenses paid by the overall fund is 2000 yuan.

4. The scope of accidental injuries in outpatient service includes fracture, joint dislocation and foreign body in respiratory tract. Payment standard: The overall fund pays 50% and the individual pays 50% of the medical expenses for outpatient treatment of the above diseases caused by accidental injuries, and the cumulative maximum payment limit of the overall fund within one year is 1 000 yuan.

To sum up, the standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. For example, if you live in a tertiary hospital, the minimum threshold for employees is 30,000 yuan, which is 15%, that is, 85%. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%.

Legal basis:

Article 20 of People's Republic of China (PRC) Social Insurance Law

The state establishes and improves the new rural social endowment insurance system.

The new rural social endowment insurance combines individual contributions, collective subsidies and government subsidies.

Article 21

The treatment of new rural social endowment insurance consists of basic pension and personal account pension.

Rural residents who participate in the new rural social endowment insurance meet the conditions stipulated by the state and receive the benefits of the new rural social endowment insurance on a monthly basis.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.