(a) continuous participation in children's medical insurance is less than 1 year, and the maximum annual payment limit of children's medical insurance fund is 1 times of the average annual salary of employees in the previous year;
(two) to participate in children's medical insurance for more than 1 year and less than 2 years, the maximum annual payment limit of children's medical insurance fund is 2 times of the average annual salary of employees in the previous year;
(three) to participate in children's medical insurance for two years and less than three years, the maximum annual payment limit of children's medical insurance fund is three times the average annual salary of employees in the previous year;
(4) For those who have participated in children's medical insurance for three years but less than four years, the maximum annual payment limit of children's medical insurance fund is four times of the average annual salary of employees in the previous year;
(five) to participate in children's medical insurance for more than 4 years, and the maximum annual payment limit of children's medical insurance fund is 200 thousand yuan.
The insured person's basic medical expenses above the deductible line for each hospitalization, or the basic medical expenses for each serious illness clinic, are within the annual maximum payment limit, and the children's medical insurance fund shall pay according to the following standards:
5000 yuan, children's medical insurance fund to pay 80%;
Children's medical insurance fund pays 85% of the part between 5000 yuan and 10000 yuan;
Children's medical insurance fund pays 90% of the part above 10000 yuan.
Disposable medical materials with a unit price exceeding 1000 yuan used in children's medical insurance projects are included in the scope of fund payment according to 90% of the domestic popular price. If there is no comparable domestic mass price, it will be included in the scope of fund payment according to 50% of the imported mass price. The expenses of beds, infusion pumps, nursing and antibiotics are only in the social security drug list, and the scope of diagnosis and treatment items and service facilities can be reimbursed according to regulations.