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.

Adult medical insurance reimbursement:

1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

5. Hospitalization.

Note: You can only enjoy medical insurance reimbursement after you have paid medical insurance for 20 years.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.