First, the general outpatient fees are settled annually. For outpatient expenses below 300 yuan, the fund pays 40%, that is, the maximum is 120 yuan/year. After the one-time settlement is completed, part of the expenses above 300 yuan need to be paid by individuals; Second, there is no minimum payment limit for outpatient expenses for serious diseases, such as hemophilia, aplastic anemia and systemic lupus erythematosus, and the medical insurance fund pays 75%; Third, hospitalization expenses, according to the level of medical institutions to set different hospitalization Qifubiaozhun and fund payment ratio. The reimbursement rates of first-,second-and third-level hospitals are 80%, 70% and 60% respectively, and the maximum payment limit of the overall fund is 50,000 yuan, and the maximum payment limit of medical insurance for serious illness reaches 6,543,800 yuan. . All insured newborns can enjoy the basic medical security benefits of hospitalization and outpatient service, and the medical expenses can be written off immediately by holding a card for medical treatment. If the newborn is insured within 3 months after birth, it can enjoy corresponding medical treatment from birth; Students who were insured before June 3 1 of that year will enjoy the corresponding medical treatment from July 1 of that year.

Legal objectivity:

For some particularly expensive serious diseases, China will establish a supplementary medical insurance reimbursement system, which will be reimbursed again on the basis of basic medical insurance reimbursement, and the actual reimbursement ratio is required to be no less than 50%. The National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, Ministry of Human Resources and Social Security, the Ministry of Civil Affairs and the China Insurance Regulatory Commission issued the Guiding Opinions on Developing Serious Illness Insurance for Urban and Rural Residents, so as to avoid poverty caused by illness and returning to poverty due to illness. The main points of the new policy of serious illness insurance for urban and rural residents are as follows: First, the medical insurance for urban residents and the insured persons of the new rural cooperative medical system are guaranteed. Second, the source of funds is drawn from the urban residents' medical insurance fund and the new rural cooperative medical fund, which does not increase the burden of individual contributions. Third, the guarantee standard is that the annual high medical expenses of patients exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents in the previous year, and the specific amount is determined by each locality. Fourth, the actual payment ratio of the insurance level is not less than 50%; In principle, the higher the medical expenses, the higher the payment ratio. V. Mode of Undertaking The government departments shall determine policies such as reimbursement, and select commercial insurance institutions to undertake the undertaking through bidding. It is understood that at present, there are more than 50 diseases in China that may cause some families to become poor or return to poverty due to illness. The National Development and Reform Commission (NDRC) said yesterday that the implementation of serious illness insurance to reimburse the high medical expenses incurred by urban and rural residents due to serious illness is aimed at avoiding poverty caused by illness and returning to poverty due to illness. The object of serious illness insurance is urban residents' medical insurance and the insured of the new rural cooperative medical system, and the required funds are extracted from the urban residents' medical insurance fund and the new rural cooperative medical system fund, without increasing the burden of individual contributions. According to the calculation, the annual per capita disposable income of urban residents or the annual per capita net income of farmers can be used as the standard of catastrophic medical expenditure of local families. When the medical expenses borne by the insured patients exceed this standard, it is likely to lead to family financial difficulties. On the basis of the reimbursement of basic medical insurance, the major illness insurance will reimburse the compliance medical expenses borne by this small group of people, and the actual reimbursement ratio is required to be no less than 50%. The compliance medical expenses here are not limited to the basic medical insurance policy, but to avoid waste and excessive burden. Items that are not necessary for basic treatment are not included in the scope of reimbursement. Commercial institutions undertake serious illness insurance. The document stipulates that the fund for serious illness insurance comes from the balance of the original medical insurance fund and is managed by commercial insurance institutions, and the way of purchasing serious illness insurance from commercial insurance institutions is adopted. Commercial insurance institutions undertaking serious illness insurance must operate special health insurance business in China for more than 5 years; Have a perfect medical insurance service network and strong professional ability; Equipped with full-time service personnel with medical and other professional backgrounds; It can realize separate accounting of serious illness insurance business and so on. At the same time, it is necessary to reasonably control the profitability of commercial insurance institutions, provide "one-stop" instant settlement services, and ensure that people can enjoy serious illness insurance benefits conveniently and in time.