1. Outpatient expenses

(1) Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals selected by individuals, Chinese medicine hospitals and Class A hospitals (Friendship, Xuanwu, Guang 'anmen Chinese Medicine, Tongren, Xiehe, Third Hospital of Beijing Medical University, Peking University People, Peking University No.1, Jishuitan, Chaoyang, Jiangong and Liangxiang).

(2) reimbursement ratio: in a natural year, the average outpatient emergency expenses incurred by on-the-job staff accumulated more than 1,8 yuan, 5% of the large medical mutual fund above 1,8 yuan was paid, and 5% was paid by individuals themselves. Retirees have accumulated more than 1,3 yuan, and the part with more than 1,3 yuan is covered with 7-year-old large-scale medical mutual funds, with 7% paid by individuals and 3% paid by individuals, 8% paid by large-scale medical mutual funds over 7 years old and 2% paid by individuals. The maximum payment limit in a natural year is 2, yuan.

(3) Medical treatment management: individual cash payment for general outpatient and emergency expenses, and the medical expenses incurred shall conform to the scope of the three major catalogues of medical insurance. When purchasing drugs, special prescriptions shall be issued in designated hospitals and stamped with the special seal for medical insurance outsourcing, and then drugs shall be purchased at designated pharmacies.

(4) reimbursement process: in a natural year, if the accumulative amount exceeds the minimum payment standard, the insured person will submit the documents to the unit or social security office, and the unit or social security office will enter the documents into the enterprise version and declare the electronic information and documents to the medical insurance center. The medical insurance center will complete the examination, settlement and payment within 15 working days.

(5) application materials: general outpatient and emergency receipts, medical insurance prescriptions (double-price prescriptions), and detailed inspection and treatment expenses.

(6) declaration date: January 2th, the expenses of the current month shall be declared the next month, and the expenses of the current year shall be declared before January 2th of the next year.

II. Hospitalization expenses

(1) Reimbursement scope: hospitalization expenses incurred by insured persons in designated hospitals or specialized hospitals of medical insurance, Chinese medicine hospitals and Class A hospitals selected by individuals.

(2) reimbursement ratio: the minimum payment for the first hospitalization in a natural year is 1,3 yuan, and every time after that, 65 yuan. The payment ratio is divided into three grades. Take the tertiary hospital as an example. The fluctuation standard is: 3, yuan, 85% on the job, 91% on the job, 9% on the job from 3, to 4,, 94% on the job, 95% on the job and 97% on the job. 9 days of general hospitalization is a settlement cycle. Psychiatric hospitalization for 36 days is a settlement cycle, and the fluctuation standard is halved. In a natural year, the overall fund will pay up to 7, yuan. The maximum amount of hospitalization is 1, yuan, and the proportion of hospitalization is 7%.

(3) Medical treatment management: Please use the Beijing Medical Insurance Manual when seeking medical treatment. If the unit pays the fee in full, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment. The medical expenses incurred should conform to the scope of the three major catalogues of medical insurance.

(4) reimbursement process: when discharged from hospital, the hospital and the individual will settle the self-funded and self-funded amount, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.

III. Outpatient special diseases

(1) Reimbursement scope: the outpatient medical expenses incurred by the insured who took anti-rejection drugs after malignant tumor radiotherapy and chemotherapy, renal dialysis and kidney transplantation after going through the examination and approval procedures for special diseases.

(2) reimbursement ratio: reimbursement ratio is the same as hospitalization. The settlement period of outpatient special diseases is 36 days.

(3) management of medical treatment: the insured can only choose one hospital as the designated hospital for special diseases. Please use the Beijing Medical Insurance Manual when seeking medical treatment. If the unit pays the fee in full, the individual only needs to pay the individual's own expenses and the self-funded part, and the reimbursement amount of the overall fund is settled by the hospital and the district medical insurance center.

(4) reimbursement process: the insured person submits the documents to the unit or social security office, and the unit declares the documents to the medical insurance center. The medical insurance center completed the audit, settlement and payment on the same day.