(1) Minors and students at school are paid according to the proportion of 85% in first-class medical institutions, 75% in second-class medical institutions and 65% in third-class medical institutions.
(2) Other urban and rural residents pay 85% in primary medical institutions, 70% in secondary medical institutions and 55% in tertiary medical institutions.
Two, outpatient treatment of chronic diseases, the insured in accordance with the provisions of the outpatient designated chronic disease outpatient specialist drug costs, the overall fund according to the proportion of primary medical institutions to pay 70%, other designated medical institutions to pay 50%. Co-ordinate the fund to pay the highest 50 yuan per person per disease month, and the excess will be paid by the insured.
Three, outpatient medical insurance benefits, the insured in accordance with the provisions of the general outpatient drug costs, paid by the overall fund in accordance with the following provisions:
(a) minors and students in the selected primary medical institutions for medical treatment according to the proportion of 80% payment; Within 30 days after referral from designated medical institutions at the grass-roots level, other designated medical institutions and designated specialized medical institutions pay 50% for medical treatment; Without referral from designated medical institutions at the grass-roots level, 40% will be paid directly to other designated medical institutions and designated specialized medical institutions for medical treatment.
(two) other residents in the selected primary medical institutions outpatient treatment according to the proportion of 60% payment.
(three) the insured in the implementation of the basic drug system approved by the health department, and the implementation of the zero-difference sales of basic drugs in designated medical institutions for medical treatment, the general medical expenses paid 70%.
(four) the overall fund to pay for the general outpatient medicine, minors and students per year does not exceed 65,438+0,000 yuan, other urban and rural residents per year does not exceed 600 yuan.
Legal basis: Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers.
Twenty-eighth personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.
Twenty-ninth serious illness hospitalization medical expenses, according to the following methods to pay:
(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.
(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.
(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.
The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.
Thirtieth medical expenses below Qifubiaozhun and above the maximum payment limit shall not be paid by the overall fund.