1. The basic medical insurance for urban residents is an integral part of social medical insurance and is mandatory. A medical insurance system led by the government, with individual (family) contributions as the main contribution, supplemented by appropriate government subsidies, is adopted to provide medical needs for urban residents in accordance with the principle of consistent payment standards and treatment levels.
2. The basic medical insurance for urban residents is a medical insurance system that is organized and implemented by the government, mainly based on family contributions and appropriate financial subsidies, and mainly based on serious illness. The basic medical insurance fund for urban residents is mainly used to pay the medical expenses of insured residents for hospitalization and outpatient serious illness and outpatient rescue. The scope and standard of payment shall be implemented in accordance with the drug list of basic medical insurance for urban residents in Yunnan Province, the scope and standard of diagnosis and treatment items and the scope of medical service facilities.
3. The proportion of payment is paid by the fund, and the proportion is determined according to different levels of medical institutions. The proportion of funds paid by first-class (including community health service centers), second-class and third-class medical institutions is 75%, 60% and 50% respectively. After two years of continuous insurance payment for urban residents, it can be increased to 80%, 65% and 55% respectively. (In other words, the smaller the hospitalization, the more you report. )
4. Basic guarantee: In a natural year, the maximum payment limit of the basic medical insurance pooling fund is 6.5438+0.6 million yuan per person per year. For patients with chronic renal failure (outpatient dialysis treatment), malignant tumor (outpatient radiotherapy and chemotherapy), organ transplantation and anti-rejection treatment, systemic lupus erythematosus, aplastic anemia (referred to as "outpatient serious illness"), the maximum payment limit of the annual pooling fund can be increased to 20,000 yuan per person.
Legal basis:
"Regulations on Handling Medical Accidents" Article 23 Employees shall participate in basic medical insurance for employees, and employers and employees shall pay basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Article 25 The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.