The maximum reimbursement amount of urban residents’ medical insurance for outpatient reimbursement: 2,000 yuan. The maximum reimbursement amount of urban employee medical insurance for outpatient reimbursement: 20,000 yuan. Additional explanation: 1. The maximum reimbursement amount refers to a medical insurance policy.

Paid cumulatively during the year.

2. The maximum hospitalization reimbursement limit of urban employee medical insurance is 300,000 yuan. The maximum payment limit of the basic medical insurance pooling fund is 100,000 yuan, and the cumulative maximum payment limit of large mutual aid funds is 200,000 yuan.

Compensation standards for medical insurance (1) Personal accident insurance is 80,000 yuan, and the compensation ratio within the scope of insurance liability is 100%.

Medical insurance covers 25,000 yuan, and the outpatient medical compensation ratio is 90%. The compensation amount per person per day does not exceed 150 yuan; hospitalization does not exceed 10,000 yuan, and the compensation ratio is 100%; hospitalization is 10,000 to 25,000 yuan, and the compensation ratio is 90%.

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(2) When the insured receives treatment at a designated outpatient clinic, the full payment will be settled by the insured person. The insurance company will review the compensation in accordance with regulations, but the original prescription and medication receipt must be provided.

(3) Regardless of outpatient or inpatient treatment, the insured must take medications according to the public medical standards of the Department of Health and the Social Labor Insurance Company.

(4) The insured person should provide the following documents when applying to the insurer for compensation of medical expenses: original outpatient medical records and attachments to prescriptions, copies of inpatient medical records (including homepage, records, discharge summary, long and short medical orders), and original receipts for medical expenses.

(5) When the insured applies for outpatient medical expense compensation, the claim should be filed in order of outpatient date. The date of the medical expense document for this claim must be after the last claim date, otherwise, the insurer has the right to refuse compensation.

If the insured commits fraud, the insurer may refuse to pay part or all of the medical expenses, depending on the severity of the case.

(6) When the insured applies for hospitalization medical expense compensation, the insurer will provide services in accordance with the following provisions. It will send someone to collect the insured's compensation application information from the contact person designated by the insured on the agreed date every month. The insurance premium will be settled annually.

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Most people choose commercial medical insurance for medical insurance, such as the Lekang worry-free refundable hospitalization medical insurance plan of China Merchants Bank. The product advantages include: 70-year long-term protection: a minimum investment of 5 yuan per day, and the payment is guaranteed for 15 years.

to age 70.

7 times subsidy care: 30 types of diseases are covered, with a maximum cumulative subsidy of 7 times, up to 1,050 yuan/day.

128% refund of premium: When the contract expires, 128% of the premium will be refunded.

Free top-notch medical opinion: an additional year of world-class "Second Medical Opinion Service" will be given to ensure timely and effective treatment.

Exemption from premiums: If you are diagnosed with a critical illness for the first time as stipulated in the contract due to an accident or after the waiting period, you do not need to pay the remaining insurance premiums.

No conflict: No conflict with social security, full coverage for accidental diseases.

Legal basis: Article 28 of the Social Insurance Law. Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.

The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.