The medical insurance card is unlimited every day. However, there is a maximum payment limit in a year, which refers to the maximum amount of medical expenses paid by the basic medical insurance fund to the insured in a medical year. At present, the standard is about four times the average wage of employees in this city last year. If the average salary of employees last year was 1 10,000 yuan, the maximum payment limit was about 40,000 yuan.
Medical insurance can be divided into the following categories:
1. Medical insurance for urban employees: mainly refers to the medical insurance for urban employees and their families, which is paid by the employees themselves and the unit * * *;
2. Medical insurance for urban and rural residents: mainly refers to the medical insurance for rural residents, urban low-income residents and urban unemployed residents, which is paid by individual residents;
3. Critical illness insurance: It mainly refers to the medical insurance for patients with rare diseases, high incidence, difficult and serious diseases, and the expenses are shared by the government and individuals.
4. Medical assistance: it mainly refers to medical assistance for low-income, destitute, orphans and disabled people who cannot afford medical expenses, and is funded by the government;
5. Commercial medical insurance: mainly refers to the medical insurance provided by commercial insurance companies, whose coverage and payment methods are determined by the insurance companies themselves;
To sum up, there may be differences in medical insurance categories and policies in different regions. For details, please consult the local medical insurance department or relevant policy documents.
Legal basis:
Article 23 of People's Republic of China (PRC) Social Insurance Law
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the 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 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.