Propaganda of medical insurance system knowledge

About the implementation of Beijing “one old and one small”

Promotion of the medical insurance system

First, the scope of insurance for "one old and one small" major medical insurance:

1. Residents with urban household registration in this Municipality, males who are 60 years of age and females who are 50 years of age or older, should participate in urban elderly medical insurance for the elderly;

2. Registered students who have urban household registration in this city and are in various ordinary colleges and universities (full-time academic education), ordinary primary and secondary schools, secondary vocational schools, special education schools, and work-study schools in the administrative area of ​​this Municipality, and Children and adolescents (including children in child care institutions, scattered infants and other non-school children under the age of 16) should participate in the student's major illness medical insurance.

Second, the insured's payment standard:

1. Financing standards for urban elderly patients with major illnesses: 1400 yuan per person per year, including 300 yuan for urban elderly individuals and 1,100 yuan for financial assistance.

2, student and child illness medical insurance financing standards: 100 yuan per person per year (according to the school year), of which 50 yuan for individuals or families; 50 yuan for financial assistance.

Third, medical insurance benefits:

1. Outpatient medical expenses for urban elderly and unemployed residents; the starting standard is 650 yuan, the part of the deductible line is reimbursed 50%, and the maximum amount of annual outpatient payment is 3,000 yuan. Hospitalization expenses: Within one medical insurance year, the first hospitalization threshold is 1,300 yuan; the second and subsequent hospitalization thresholds are 650 yuan. The above part of the payment standard is paid 70% by the urban non-medical insurance for the elderly. The maximum amount of hospitalized cumulative payment in a medical insurance year is 180,000 yuan.

2, student and child outpatient medical expenses; the threshold for reimbursement is 650 yuan, the above-mentioned part of the payment standard is 60% reimbursed by the student's major illness medical insurance fund, and the maximum amount of payment for the outpatient clinic is 3,000 yuan per year. Inpatient medical expenses, the starting line standard is 650 yuan, the medical expenses above the threshold is 70% reimbursed, and the maximum amount of accumulated payment in a school year can reach 180,000 yuan.

4. How do the insured personnel settle the medical treatment:

In the case of urban elderly and student children hospitalized or treated for special disease outpatient treatment, the individual shall pay the advance payment first, and the medical expenses incurred shall be recorded by the designated medical institution. At the time of settlement, the part that should be paid by the major illness medical insurance fund according to the regulations shall be settled by the designated medical institution and the social security agency, and the rest of the medical expenses shall be settled by the individual and the designated medical institution.

5. The major medical insurance fund will not pay the following medical expenses:

1. Visit a medical institution other than the designated medical institution, except for emergency hospitalization;

2. Injury caused by traffic accidents, medical accidents or other liability accidents;

3. Injury caused by personal use of drugs, fights or other liability accidents;

4. Treatment for reasons such as suicide, self-harm, alcohol abuse, etc.;

5. Treated in foreign countries or Hong Kong, Macao Special Administrative Region and Taiwan;

6. According to the state and the provisions of this Municipality, it should be borne by the individual.