Overall planning of serious illness is a model of medical insurance in China. Due to limited conditions, it can only be coordinated at the municipal level. The practice of this system varies from place to place, such as the overall planning of serious illness in Beijing and the overall planning of hospitalization medical insurance in Shanghai, but they all follow the principle of minor illness diversion and overall planning of serious illness, that is, a deductible line is set, ranging from several hundred yuan to several thousand yuan, depending entirely on the local economic affordability and medical treatment level. The medical expenses below the deductible line shall be borne by the employees, exceeding.
However, the medical expenses under any of the following circumstances do not belong to the scope of overall planning:
1, except for emergency rescue in non-designated hospitals without approval;
2. Suffering from occupational diseases, work-related injuries or recurrence of old injuries;
3. Injuries caused by traffic accidents;
4. Injuries caused by my illegal acts;
5. Food poisoning caused by accidents;
6, except for mental illness caused by suicide;
7. Injuries caused by medical accidents;
8, according to the provisions of the state and the city should take care of medical expenses.
The overall fund is used to pay medical expenses, and the method of step-by-step calculation and cumulative payment is adopted. Medical expenses paid more than 2000 yuan, the specific standards are as follows:
1, pay 90% for more than 2,000 yuan and less than 5,000 yuan;
2, more than 5000 yuan 10000 yuan to pay eighty-five percent;
3, 10000 yuan more than 30000 yuan to pay 80%;
4, more than 30000 yuan to 50000 yuan to pay eighty-five percent;
5, more than 50000 yuan to pay 90%.
People's Republic of China (PRC) Social Insurance Law Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.