1, general outpatient expenses, with the annual settlement unit. For outpatient expenses below 300 yuan, the proportion of fund payment is 40%, that is, the annual settlement is the highest 120 yuan, and some expenses above 300 yuan need to be paid by individuals;

2. For outpatient expenses for serious diseases, such as hemophilia, aplastic anemia and systemic lupus erythematosus, the fund has no deductible, and the medical insurance fund pays 75%; Third, hospitalization expenses. According to the level of medical institutions, different hospitalization qifubiaozhun and fund payment ratio are set. Take a tertiary hospital as an example. The standard is above 500 yuan, and the fund payment ratio is 80%:

(1) 650 yuan, the minimum threshold for tertiary hospitals, with a reimbursement rate of 50% and an upper limit of 2,000 yuan;

(2) The Qifubiaozhun of secondary hospitals is 300 yuan, and the reimbursement rate is 60%;

(3) There is no Qifubiaozhun for the first-level hospitals, and the reimbursement rate is 65%.

Newborn medical insurance benefits:

1, reimbursement for outpatient and emergency treatment. Within one year, the deductible line of outpatient and emergency medical expenses incurred by urban and rural residents in a first-class hospital is 800 yuan, with a maximum payment limit of 3,000 yuan and a subsidy of 30%;

2. Hospitalization medical insurance benefits. According to the different levels of hospitals, the reimbursement of hospitalization medical expenses below 6.5438+0.8 million within one year will be different:

(1) A first-class hospital can reimburse 65% of the hospitalization expenses without deductible;

(2) The deductible line of the secondary hospital is 300 yuan, and the hospitalization medical expenses can be reimbursed by 60%;

(3) 500 yuan, the deductible line of tertiary hospitals, can reimburse 55% of hospitalization medical expenses.

3, outpatient special disease reimbursement treatment. For outpatient special diseases, the deductible standard within one year is 300 yuan, and the highest payment limit and reimbursement ratio are implemented according to the hospitalization reimbursement standard;

4. Student accident insurance benefits. On the basis of the basic medical insurance for urban and rural residents, it is suggested to allocate a unified accidental injury insurance for students and children to solve the problems of medical expenses compensation, disability and death allowance caused by accidental injuries of students and children.

Legal basis: Article 26 of People's Republic of China (PRC) Social Insurance Law.

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

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.