Wang, a retired employee of a unit, participated in the basic medical insurance and large medical expenses assistance in our city, and lived in our city this year due to illness.
A third-class first-class hospital spent 60,000 yuan before and after, including 6,000 yuan (15%) for Class B drugs and 2,800 yuan for drugs at its own expense.
Yuan, 300 yuan, the bed fee exceeds the standard, how much should the medical insurance agency pay? How much does Wang need to pay for his own medical expenses?
Comment and analysis
1. Deduct personal expenses before the overall fund payment:
Self-funded medicine: 2800 yuan.
Overstandard bed fee: 300 yuan.
Personal conceit of Class B drugs: 6000× 15%=900 yuan.
Total expenses deducted: 2800+300+900=4000 yuan.
2, into the overall fund and the cost of large relief funds:
60000-4000=56000 (yuan)
3. Personal expenses within the scope of overall fund payment:
(1) Qifubiaozhun: Wang lives in a tertiary medical institution, and the Qifubiaozhun is10.2% of the average social salary of last year.
Namely:10000×12% =1200 (yuan)
(2) Wang is a retired employee, the minimum threshold is 1 10,000 yuan, and the personal responsibility is 12%, that is, (1 10,000-1200)× 12%.
= 1056 (yuan)
(3) The maximum payment limit is 4 times of the average social wage of last year 1 10,000 yuan, that is, 40,000 yuan, and 40,000 yuan is above 1 10,000 yuan.
The following individuals are conceited by 9%, and this item is conceited by individuals: (40000- 10000)×9%=2700 yuan.
(4) The total amount of personal expenses within the scope of overall fund payment:
1200+1056+2700 = 4956 (yuan)
4, personal expenses within the scope of large relief funds:
Individuals pay 10% within the scope of large-scale assistance, and Lao Wang pays 56,000 yuan within the scope of large-scale assistance.
40,000 yuan =16,000 yuan, and this item is personally conceited:16,000×10% =1600 yuan.
5. Total personal expenses of Wang:
Personal conceit deducted before the overall fund payment+personal conceit within the scope of the overall fund payment+large amount of assistance.
Personal conceit, namely: 4000+4956+1600 =10556 (yuan)
Therefore, Wang needs to pay medical expenses 10556 yuan.
The medical insurance agency should pay: 60000- 10556=49444 yuan.