(two) primary and secondary school students and infants per person per year 90 yuan.
Second, outpatient and emergency treatment
The outpatient and emergency treatment and hospitalization benefits are as follows: the deductible line of outpatient and emergency treatment is 300 yuan/year, and the reimbursement rate of the first-level hospital is 65%, the reimbursement rate of the second-level hospital is 55%, and the reimbursement rate of the third-level hospital is 50%; The qifubiaozhun of first-class hospitals is 50 yuan/time, and the proportion of medical insurance reimbursement is 80%; The qifubiaozhun of secondary hospitals is 100 yuan/time, and the proportion of medical insurance reimbursement is 70%; The qifubiaozhun for tertiary hospitals is 300 yuan/visit, and the proportion of medical insurance reimbursement is 60%. For those who are insured beyond the time limit, except for newborns and newly qualified personnel, a waiting period of 3 months will be set, and residents will enjoy medical insurance benefits after the waiting period expires.
Third, the hospitalization standard
If the medical expenses incurred in hospitalization exceed the minimum deductible, the proportion of fund payment will be adjusted accordingly, specifically: for hospitalization in community health service centers (or first-class medical institutions), the proportion of fund payment will be adjusted from 75% to 80%; If you are hospitalized in a secondary medical institution, the fund payment ratio will be adjusted from 65% to 70%; For tertiary medical institutions, the proportion of fund payment is adjusted from 55% to 60%.
Legal basis: Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers.
Twenty-eighth personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.
Twenty-ninth serious illness hospitalization medical expenses, according to the following methods to pay:
(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.
(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.
(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.
The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.
Thirtieth medical expenses below Qifubiaozhun and above the maximum payment limit shall not be paid by the overall fund.