(1) General outpatient medical expenses. The deductible for outpatient co-ordination of urban and rural residents (except college students) is 100 yuan, and the outpatient co-ordination fund is paid at the rate of 50%, and the individual bears 50%. The annual maximum payment limit of outpatient co-ordination fund is 200 yuan, which is included in the annual payment limit of basic medical insurance fund for urban and rural residents.

The general outpatient treatment of college students shall be formulated separately by the Municipal Medical Security Bureau and the Municipal Finance Bureau.

(2) General medical expenses. Medical institutions at or below the first level (hereinafter referred to as agreed medical institutions) that implement the zero-difference rate of drugs and sign an agreement with the agency shall implement the subsidy policy for general medical expenses. General medical expenses include: registration fee, medical treatment fee, injection fee (including intravenous infusion fee, excluding medicine fee and disposable materials fee) and pharmaceutical service fee. The basic medical insurance fund subsidy standard is: 3 yuan per person per day for outpatient treatment of insured urban and rural residents, and the specific payment method and service fee method for contracted doctors shall be formulated separately by the municipal medical security department. The standard of general medical expenses shall be adjusted in a timely manner according to relevant regulations.

(three) "two diseases" outpatient drugs, chronic diseases, special diseases and critical diseases of medical expenses. Within the scope of the "two diseases" policy, there is no deductible for outpatient medical expenses, and the payment ratio is 50%; The deductible line of outpatient medical expenses for chronic diseases is 200 yuan (except for dysfunction in COVID-19), and the payment ratio is 60%. There is no deductible for dysfunction in COVID-19, and the payment ratio is 60%. There is no deductible for outpatient medical expenses for special diseases, and the payment ratio is 80% (except hemophilia). The proportion of outpatient medical expenses for hemophilia is 85% in secondary medical institutions and 80% in tertiary medical institutions. The outpatient medical expenses, deductible line and payment ratio of critical and rescue diseases shall be implemented with reference to the hospitalization treatment of the insured place.

The specific measures for the administration of "two diseases" outpatient drugs, chronic diseases, special diseases and critical diseases shall be formulated separately by the Municipal Medical Security Bureau.

(four) the medical expenses of phacoemulsification and intraocular lens implantation. Meet the treatment conditions of cataract recovery project, and carry out outpatient monocular cataract phacoemulsification and intraocular lens implantation in the designated medical institutions of cataract recovery project signed by the agency, and pay 500 yuan for each case; Those who do not meet the treatment conditions will be treated in the agreed medical institutions, with a limit of 1300 yuan per case.

(five) special provisions of drug medical expenses. The quantity, name, annual payment limit and payment proportion of drugs with special provisions shall be formulated separately by the Municipal Medical Insurance Bureau.

Hospitalization

(a) insured residents in Xinhua District, qiaoxi district, Chang 'an District, Yuhua District, high-tech zone level medical institutions in hospital, each deductible for 200 yuan, the payment ratio of 90%; The deductible line of secondary medical institutions is 800 yuan, and the payment ratio is 75%; The deductible line of municipal tertiary medical institutions is 1000 yuan each time, and the payment ratio is 65%; The deductible line of provincial tertiary medical institutions is 1500 yuan, and the payment ratio is 60%.

The hospitalization deductible line and payment ratio of tertiary medical institutions in Beijing, Tianjin and other cities that are included in the designated scope of medical insurance in our city shall be implemented according to the standards of tertiary medical institutions at the provincial level.

(2) Insured residents are hospitalized in the first-level and below medical institutions outside Xinhua District, qiaoxi district, Chang 'an District, Yuhua District and High-tech Zone, and the deductible line is 100 yuan each time, and the payment ratio is 92%; The deductible line of county-level secondary medical institutions is 400 yuan, and the payment ratio is 80%.

(3) Insured residents are hospitalized in traditional Chinese medicine hospitals in the city, and the deductible for each hospitalization is lower than that of general hospitals at the same level 100 yuan, with the lowest 100 yuan; The reimbursement rate is 3 percentage points higher than that of hospitalization in general hospitals at the same level, and the highest reimbursement rate does not exceed 97%.

(4) Insured residents are hospitalized in designated medical institutions, and the medical expenses charged by designated medical institutions for single diseases, day operations and other diseases according to regulations shall be settled in a fixed amount, with no deductible and no project pricing.

(5) In the medical association (* * *), if the insured residents need to be transferred to the next medical institution due to the same disease and the treatment is uninterrupted, the hospitalization deductible line of the lower medical institution will not be deducted when calculating the hospitalization reimbursement expenses of the lower medical institution; If the patient is transferred to a higher-level medical institution without interrupting the treatment, the deductible expenses of the lower-level medical institution shall be deducted from the deductible expenses of the higher-level medical institution when calculating the hospitalization reimbursement expenses.

(VI) If a medical institution has opened a direct settlement agreement for medical treatment in different places inside and outside the province, the deductible line and payment ratio shall be implemented according to the hospitalization standard of medical institutions at the same level in this municipality, so as to realize medical treatment in the province.

(seven) after filing, transferred to medical institutions outside the province for hospitalization, each deductible is 2000 yuan, and the payment ratio is 50%. Without filing, he was transferred to a medical institution outside the province for hospitalization, with a deductible of 4,000 yuan and a payment ratio of 30%. Self-funded medical expenses are not included in serious illness insurance; Transfer to a non-medical insurance agreement medical institution in a different place for hospitalization, and the basic medical insurance fund and serious illness insurance will not be paid.

(8) The hospitalization expenses incurred by long-term residents in different places who have gone through the formalities for filing medical treatment in different places at their place of residence shall be implemented according to the hospitalization deductible line and payment ratio of medical institutions at the same level in this Municipality.

(9) For medical institutions that are not rated, the deductible line and payment ratio shall be determined with reference to medical institutions with the same basic standards.

Article 17? The number of years for urban and rural residents to pay medical insurance premiums is linked to the proportion of hospitalization expenses and outpatient payment for special diseases. From the second year of insurance payment, the payment ratio will increase by 1 percentage point for each additional payment year. If there is such a policy before 20 17, the maximum shall not exceed 8 percentage points; After 20 17, the maximum premium for continuous payment shall not exceed 8 percentage points. Interrupt the insurance and recalculate the accumulated payment period. The proportion of medical expenses paid by the basic medical insurance fund for urban and rural residents shall not exceed 95%, and the proportion of medical expenses paid by the basic medical insurance fund for inpatients in Chinese medicine hospitals within the city shall not exceed 97%.

Article 18? Delivery and hospitalization within the scope of the policy:

(a) the limit of natural childbirth is 1000 yuan;

(2) The limit of cesarean section is 1750 yuan.

Nineteenth insured urban and rural residents, the use of class A drugs, class A medical services to pay medical expenses according to the provisions of the individual and the basic medical insurance fund burden ratio; Individuals who use Class B drugs pay 5% first (unless there are special provisions), and the remaining 95% are paid according to the proportion stipulated by individuals and basic medical insurance funds; For the use of Class B medical services, the individual pays 15% first (5% for renal dialysis), and the remaining 85% (95% for renal dialysis) is paid according to the specified proportion of individual and basic medical insurance fund.

Article 20? Insured urban and rural residents use disposable articles specified by Hebei Province (except Class C). The individual pays 30% first, and the remaining 70% is paid according to the proportion stipulated by the individual and the basic medical insurance fund.

Article 21? The annual limit for the basic medical insurance fund to pay various medical expenses is 200,000 yuan.

Article 22? The expenses included in the reimbursement scope of the basic medical insurance for urban and rural residents refer to the expenses that meet the relevant provisions of the basic medical insurance. The catalogue of basic medical insurance drugs, diagnosis and treatment items and medical service facilities shall be implemented in accordance with the relevant provisions of Hebei Province.

Article 23? The scope of the basic medical insurance fund will not be paid:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(four) in foreign countries and Hongkong, Macao and Taiwan Province province for medical treatment;

(five) physical fitness, health care consumption, health examination;

(6) While serving a sentence in prison;

(seven) other expenses that are not paid by the basic medical insurance fund stipulated by the state.

Article 24? The time for insured urban and rural residents to enjoy medical insurance benefits is 10 month/kloc-0 to February 1.