1, outpatient reimbursement, general outpatient service does not have a deductible line, and all insured residents enjoy the treatment of general outpatient service. In a medical insurance year, there is no deductible for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed at the rate of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan;
2. The proportion of hospitalization reimbursement. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every five years after the continuous payment time, 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;
3, the proportion of second reimbursement, after the second reimbursement, there may be a "second reimbursement" in the medical expenses incurred by the insured residents in a single hospitalization, which belongs to the part of the urban residents' basic medical insurance pooling fund. After the basic medical insurance fund is paid in proportion, if the personal burden exceeds 8,000 yuan, the serious illness insurance fund will reimburse the excess part by 55%;
4. Reimbursement amount: residents who participate in medical insurance for urban residents can be reimbursed up to 370,000 yuan per year. Their annual payment limit of basic medical insurance is 6.5438+0.2 million yuan, and the payment limit of serious illness insurance is 250,000 yuan.
Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).
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.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.