Large medical insurance for retired workers in Guiyang

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Hello: On the basis of basic medical insurance, large medical insurance is paid by the employer at the base of 1% for employees and retirees, and each employee and retiree pays large medical insurance premiums in the form of 2 yuan money every month (the payment amount of large medical insurance varies from region to region). Employers, employees and retirees who participate in the municipal overall planning of basic medical insurance shall participate in the mutual insurance of large medical expenses while participating in the basic medical insurance. Employees and retirees who pay large medical insurance premiums enjoy large medical insurance benefits. When the medical expenses exceed the maximum payment limit of the basic medical insurance pooling fund, large medical insurance will pay their medical expenses. The scope of medical expenses paid by large medical insurance is the same as that of basic medical insurance.

Treatment of mutual fund for large medical expenses

The mutual fund for large medical expenses shall pay large medical expenses in accordance with the provisions of the basic medical insurance in the following ways:

1. For the part of outpatient and emergency medical expenses exceeding 2,000 yuan within one year, 50% of the large medical expenses will be paid by mutual funds and 50% by individuals.

2. For retirees whose outpatient and emergency medical expenses exceed 1300 yuan in a year, 70% will be paid by the mutual fund for large medical expenses and 30% will be paid by the individual; For retirees over 70 years old, 80% of the large medical expenses are paid by mutual funds and 20% by individuals.

3 workers and retirees outpatient and emergency medical expenses within a year of large medical expenses mutual fund maximum payment limit of 20000 yuan.

4. Employees and retirees exceed the maximum payment limit of the basic medical insurance pooling fund (excluding the following Qifubiaozhun and personal burden) for hospitalization medical expenses, outpatient medical expenses for taking anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, renal dialysis and kidney transplantation, and 70% for mutual funds for large medical expenses and 30% for individuals. However, the maximum amount of medical expenses paid by mutual funds in one year is 654.38+10,000 yuan.

After the insured's hospitalization medical expenses exceed the maximum payment limit of the basic medical insurance pooling fund, the unit or hospital shall fill in the "Declaration Form for Large Medical Pooling Expenses" and report to the Medical Insurance Bureau. In terms of medical care, except for the part paid by individuals, large medical expenses are settled by hospitals and medical insurance bureaus; Referral for medical treatment, by the unit with the "medical declaration form", hospitalization expenses receipt, discharge summary, cost list to the Municipal Medical Insurance Bureau for reimbursement. The reimbursement rate of large medical expenses is 90% (80% for those transferred to other hospitals), and the maximum payment limit of large medical insurance fund within 12 months is125,000 yuan (excluding 25,000 yuan paid by the basic medical insurance pooling fund).

The insured pays large medical expenses in proportion.

After the insured person enters the large medical insurance payment, the medical expenses that meet the requirements of the basic medical insurance for in-patient and outpatient emergency rescue, outpatient treatment of serious diseases and chronic diseases shall be accumulated by the large medical insurance fund and the insured person in proportion, with the same burden. The specific criteria are:

(a) more than 45 thousand yuan to 6.5438 million yuan (including 6.5438 million yuan), 94% of the large medical insurance fund, and 6% of the insured person pays; 65438+ 10,000 yuan to 200,000 yuan (including 200,000 yuan), 96% paid by the large medical insurance fund and 4% paid by the insured; More than 200,000 yuan, 98% is paid by the large medical insurance fund, and 2% is paid by the insured.

(II) If the medical expenses of the insured for using the diagnosis and treatment items and Class B drugs in the basic medical insurance drug list belong to the basic medical insurance pooling fund, 65,438+00% shall be paid by the individual first, and 30% shall be paid by the individual for the approved blood use, and the balance shall be borne by the large medical insurance and the insured according to the prescribed proportion.

(3) The insured uses artificial organs and implanted materials in vivo that meet the requirements of the basic medical insurance, of which individuals pay 35% and large medical insurance pays 65%; If it is imported, the individual will pay 50% and the large medical insurance will pay 50%.

Large medical insurance can compensate up to 300 thousand yuan

According to the relevant regulations, the maximum amount of medical expenses paid to each insured person in a large medical insurance year is 300,000 yuan.

Reimbursement method of large medical expenses

The large medical expenses paid by the insured in the designated hospitals shall be reimbursed by the designated hospitals to the large medical insurance office after the insured pays the self-payment ratio to the designated hospitals in accordance with the regulations; The insured person goes to the referral hospital for medical treatment. Because the large medical expenses are paid in advance by the individual, such personnel should submit medical records, invoices and lists to the large medical insurance office for reimbursement; For insured persons who have incurred large medical expenses in designated hospitals, they can submit medical records, invoices and lists to the big medical insurance office for reimbursement after discharge.