The specific treatment standards are as follows: The maximum payment limit of the resident medical insurance fund is linked to the individual payment period.

For medical expenses incurred by insured persons within a benefit year, the fund’s maximum cumulative payment limit is 300,000 yuan.

For every additional year of continuous payment, the maximum payment limit increases by 10,000 yuan, up to a maximum of 360,000 yuan.

If payment is interrupted and insured again, the maximum payment limit of the fund will be recalculated based on the first year (300,000).

1. Outpatient coordinated benefits and outpatient high-cost compensation benefits (1) The minimum payment standard for outpatient coordinated benefits is 200 yuan (the part below 200 yuan is borne by the individual). Outpatient (emergency) medical expenses incurred within a benefit year are treated in community medical institutions.

If the patient is treated in a non-community medical institution, the fund will pay 30%, and the annual fund payment limit is 300 yuan.

The fund payment ratio for elderly residents over 80 years old will be increased by 5 percentage points based on the above payment ratio, and the annual fund payment limit will be increased by 10%.

Table 1. Outpatient Co-ordinated Benefits Table (2) Outpatient High-cost Compensation Benefits Within a treatment year, after enjoying the outpatient co-ordinated benefits, the outpatient medical expenses that continue to occur will be paid by the individual out of pocket for more than 2,000 yuan. If the patient is treated in a community medical institution, the fund will pay

50%. For treatment in non-community medical institutions, the fund pays 30%. The annual fund payment limit is 2,600 yuan.

Table 2. Compensation benefit table for high outpatient expenses. Note: In 2022, the annual fund payment limit for high outpatient expense compensation will be increased to 2,800 yuan/year.

Outpatient co-ordination and compensation for high outpatient expenses are implemented through a first-diagnosis and referral system based on designated community health service institutions.

Insured residents (except students and children) receive their first diagnosis at designated community health service institutions or medical institutions that refer to community management; specialized hospitals can serve as the first medical institutions for all insured persons.

If the insured person needs to be referred, the first medical institution will be responsible for the referral. The outpatient medical expenses incurred if the first consultation or referral is not carried out in accordance with the regulations shall be borne by the individual (except for emergency cases and rescue).

Table 3. List of designated medical institutions for outpatient referral 2. "Two diseases" treatment for residents (1) Identification and registration at a secondary hospital or community health service center (health center), confirmed by an internal medicine or specialist physician, to handle hypertension and diabetes

After certification and registration, the medical institution completes the information entry procedures for the insured persons, and then they can enjoy the outpatient overall treatment according to regulations.

(2) Medical benefits: The medical expenses for drugs, diagnosis and treatment services and other medical expenses for "two diseases" incurred by persons with "two diseases" within the scope of medical insurance in designated medical institutions will be included in the scope of outpatient overall payment.

The minimum payment standard and fund payment ratio are consistent with the outpatient overall treatment, and the fund payment limit is increased based on the outpatient overall plan.

Table 3. Outpatient treatment for "two diseases" personnel: Outpatient treatment for serious illnesses (1) Outpatient treatment for serious illnesses includes malignant tumors, hemodialysis (including peritoneal dialysis) treatment for severe uremia, anti-rejection treatment after organ transplantation, and hemophilia

, aplastic anemic disorder, systemic lupus erythematosus.

(2) Insured residents who are registered as suffering from the above outpatient serious diseases can apply for disease recognition to the third-level designated medical institutions in this city with certification qualifications.

(3) Medical benefits 1. For outpatient treatment of malignant tumors for insured residents with malignant tumors, the fund payment limit is 120,000 for outpatient radiotherapy and chemotherapy (referring to intravenous or interventional chemotherapy) medical expenses incurred in designated designated medical institutions.

yuan/year; targeted drug treatments such as endocrine therapy for breast cancer and prostate cancer, immunotherapy for kidney cancer and melanoma, oral chemotherapy for malignant tumors (including molecular targeted drugs), bladder instillation, anti-bone metastasis or late-stage analgesic treatment

For expenses, within five years from the date of diagnosis, the fund payment limit is 80,000 yuan/year. If treatment is still required after five years, the treatment period can be extended after evaluation by a designated designated medical institution; except for radiotherapy, chemotherapy and targeted treatment,

For auxiliary treatment expenses other than drug treatment, the fund payment limit is: 10,000 yuan/year for the first to three years, 5,000 yuan/year for the fourth to fifth years, and 2,000 yuan/year for the sixth and subsequent years.

Table 4. Malignant tumors, outpatient treatment benefits Table 2. Chronic renal failure outpatient dialysis treatment For insured persons with chronic renal failure outpatient dialysis treatment (including hemodialysis and peritoneal dialysis), the limit of dialysis medical expenses incurred in prescribed designated medical institutions is

63,000 yuan/year. For auxiliary examination and medication medical expenses, the fund payment limit is 8,000 yuan/year.

Table 5. Benefits of outpatient dialysis treatment for chronic renal failure. Table 3. Outpatient anti-rejection treatment after organ transplantation. For anti-rejection drug treatment expenses incurred in prescribed designated medical institutions, the fund payment limit is: 80,000 yuan in the first year, and

75,000 yuan in the second year, 70,000 yuan in the third year, and 65,000 yuan/year in the fourth year and thereafter.