1. Coverage: Tangshan basic medical insurance for urban workers and basic medical insurance for urban and rural residents.
2. Insurance age: unlimited.
3, health status: free of medical examination, past diseases can be insured and paid.
4. Waiting period: There is no waiting period.
5. Warranty period: 2022 1 October 1 to February 20221.
6. Payment method: wholesale delivery
7. Insurance premium: 129 yuan/person/year.
(1) The medical insurance premium for chronic (special) diseases in medical insurance coverage, with the maximum insured amount of 1 ten thousand yuan. After deducting the annual deductible10.5 million yuan, 80% of people with non-previous diseases and 40% of people with previous diseases will be paid insurance money.
(2) The medical expenses paid by specific inpatients outside the scope of medical insurance, with the maximum insured amount of 6,543.8+0,000 yuan. After deducting the annual deductible of 6.5438+0.5 million yuan, 80% of patients with no past diseases and 40% of patients with past diseases will receive insurance money. Among them, the one-time payment limit for hospitalized surgical materials is 60,000 yuan.
(3) For 55 kinds of specific high-priced drugs, the maximum insured amount is 654.38+0,000 yuan, with zero deductible, and 80% of people with non-past diseases and 40% of people with past diseases pay insurance money.
(4) The insurance premium of three kinds of drugs for specific rare diseases, with a maximum insured amount of 500,000 yuan and zero deductible, will be paid by 80% for those without previous diseases and 40% for those with previous diseases.
(5) The insurance premium for two CAR-T treatments for specific drugs, with a maximum insured amount of 6,543.8+0,000 yuan and zero deductible, will be paid by 80% for those without previous diseases, and will not be paid for those with previous diseases.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(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;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.