Specific terms and benefits of social security medical insurance

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Employee outpatient clinics, purchase of medicines and hospitalization personal out-of-pocket part of the medical expenses are settled directly by the IC card of the medical insurance personal account, and the exceeding expenses are paid by the participant's personal cash. Within three days of the hospitalization of the insured person, the patient's family members or entrusted by the medical insurance card to the social security center for the record. The social security center has the right to refuse to insure the medical expenses of those who have not registered for the record, except for special circumstances. From the 15th to the 20th of each month, the insured person who is discharged from the hospital shall reimburse his/her medical expenses to the social security center with his/her medical insurance card, hospitalization diagnosis, and the receipt of the hospitalization medical fee schedule. Employees applying for outpatient chronic disease management should first register at the Social Security Center and wait for the Social Security Center to notify them for medical appraisal.

The Coordinated Fund has a starting standard and a maximum payment limit. The starting standard for the first hospitalization medical expenses is RMB 1,000; for multiple hospitalizations within a year, the cumulative starting standard is RMB 1,500. Individuals are responsible for hospitalization medical expenses below the threshold, while hospitalization medical expenses above the threshold and below the maximum payment limit are paid by the coordinated fund on a segmented and proportional basis.

The coordinated fund pays 0.8 for the portion of hospitalization medical expenses above the starting standard up to RMB 10,000;

The coordinated fund pays 0.82 for the portion of hospitalization medical expenses above RMB 10,000 up to RMB 25,000;

The coordinated fund pays 0.83 for the portion of hospitalization medical expenses above RMB 25,000 up to RMB 50,000.

Retirement The proportion of payment by the co-ordinated fund for retirees will be increased by 5 percentage points for each segment. Outpatient medical expenses for special diseases that are included in the scope of payment of the co-ordination fund according to the regulations, the starting standard of the co-ordination fund within the year is 1,000 yuan, and outpatient medical expenses above the starting standard are paid by the co-ordination fund.8