1. The medical insurance fund will pay 50% and the individual will pay 50% for the part of outpatient and emergency medical expenses exceeding 2000 yuan in a year.
2. For retirees whose outpatient and emergency medical expenses exceed 1300 yuan in a year, 70% will be paid by medical insurance fund and 30% by individuals for retirees under 70 years old; For retirees over 70 years old, the medical insurance fund pays 80% and the individual pays 20%. The maximum payment limit of medical insurance fund for outpatient and emergency medical expenses of employees and retirees within one year is 20,000 yuan.
2. Payment method of hospitalization expenses:
1. The minimum deductible for hospitalization of the basic medical insurance fund in our city is 1300 yuan, and the maximum payment ceiling is 70,000 yuan.
* The mental patient is in a psychiatric hospital or psychiatric ward of a general hospital, and the deductible line for hospitalization is 650 yuan. Within 360 days, only one deductible line will be accepted.
2. Enjoy the minimum living guarantee for urban residents in this city, the minimum threshold will be halved, and the mental patient will be 325 yuan.
3. The proportion of personal burden of medical expenses between the deductible line and the capping line is calculated by segments according to the level of the hospital and the amount of expenses. The cumulative payment method is paid by the basic medical insurance fund and individuals in proportion.
Three. The basic medical insurance fund shall not pay the following medical expenses:
1. See a doctor in a medical institution other than my designated place, except for emergency;
2. Buy medicines at non-designated retail pharmacies;
3. Injuries caused by traffic accidents, medical accidents or other accidents;
4 drug abuse, fighting or other illegal acts causing injuries;
5 because of suicide, self-mutilation, alcoholism and other reasons to receive treatment (except mental patients);
6 medical expenses incurred in scientific research and clinical trials;
7. Receiving treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province;
8 in accordance with the provisions of the state and the city should be paid by individuals.