The mutual fund for large medical expenses shall pay large medical expenses in accordance with the provisions of the basic medical insurance in the following ways:
1. For the part of outpatient and emergency medical expenses exceeding 2,000 yuan within one year, 50% of the large medical expenses will be paid by mutual funds and 50% by individuals.
2. For retirees whose outpatient and emergency medical expenses exceed 1300 yuan in a year, 70% will be paid by the mutual fund for large medical expenses and 30% will be paid by the individual; For retirees over 70 years old, 80% of the large medical expenses are paid by mutual funds and 20% by individuals.
3 workers and retirees outpatient and emergency medical expenses within a year of large medical expenses mutual fund maximum payment limit of 20000 yuan.
4. Employees and retirees exceed the maximum payment limit of the basic medical insurance pooling fund (excluding the following Qifubiaozhun and personal burden) for hospitalization medical expenses, outpatient medical expenses for taking anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, renal dialysis and kidney transplantation, and 70% for mutual funds for large medical expenses and 30% for individuals. However, the maximum amount of medical expenses paid by mutual funds in one year is 654.38+10,000 yuan.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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 of People's Republic of China (PRC) Social Insurance Law
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.
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 24 of People's Republic of China (PRC) Social Insurance Law
The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 of People's Republic of China (PRC) Social Insurance Law
The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.