Annual reimbursement limit of medical insurance

Maximum reimbursement amount of medical insurance for urban residents

Outpatient reimbursement: 2,000 yuan

Reimbursement for hospitalization: 6,543,800 yuan+7,000 yuan

Maximum reimbursement amount of medical insurance for urban workers

Outpatient reimbursement: 20,000 yuan

Hospitalization reimbursement: 300,000 yuan

Supplementary explanation:

1, and the maximum reimbursement amount refers to the accumulated payment in a medical insurance year.

2. The maximum reimbursement limit of medical insurance for urban workers is 300,000 yuan, including 654.38+million yuan for the basic medical insurance pooling fund and 200,000 yuan for the accumulated large mutual fund.

Payment standard of medical insurance

(1) Personal accident insurance is 80,000 yuan, and the proportion of compensation within the scope of insurance liability is 100%. The medical insurance is 25,000 yuan, the proportion of outpatient medical compensation is 90%, and the compensation amount per person per day does not exceed 150 yuan; Hospitalization does not exceed 1 1,000 yuan, and the compensation ratio is 1 1,000%; The hospitalization expenses 1 10,000 to 25,000 yuan, and the compensation ratio is 90%.

(2) When the insured is in the designated outpatient service, all the expenses will be settled by himself, and the insurer will review the compensation according to the regulations, but the original prescription and medicine fee receipt should be provided.

(3) The insured shall use drugs according to the free medical standard provided by the health department and social labor insurance company regardless of outpatient or hospitalization treatment.

(4) When applying for compensation for medical expenses from the insurer, the insured shall provide the following documents: original outpatient medical records and attached prescriptions, copies of inpatient medical records (including home page, records, discharge summary, long and short doctor's orders), and original medical expense receipts.

(5) When the insured applies for compensation for outpatient medical expenses, he should file a claim according to the date of outpatient service, and the date of the medical expenses document of this claim must be after the date of the last claim, otherwise, the insurer has the right to refuse compensation. If the insured practices fraud, the insurer may refuse to pay part or all of the medical expenses according to the seriousness of the case.

(6) When the insured applies for compensation for hospitalization medical expenses, the insurer shall provide services according to the following provisions, and send someone to the contact person designated by the insured to receive the compensation application materials on the agreed date every month, and the insurance premium shall be settled once a year.

Medical Insurance Most people choose commercial medical insurance, such as China Merchants Bank and Netcom's Le Kang worry-free return hospitalization medical insurance plan. Product advantages are as follows:

70-year super-long guarantee: minimum 5 yuan investment per day, 15 years, guarantee to 70 years old.

7 times subsidy care: 30 kinds of diseases are guaranteed, and the maximum subsidy is 7 times, reaching 1050 yuan/day.

128% premium return: return at the expiration of the contract 128% premium.

Free top medical advice: extra 1 year of the world's top second medical advice service to ensure timely and effective treatment.

Exemption from premium: the first diagnosis is made after the waiting period due to an accident or serious illness agreed in the contract, and there is no need to pay the remaining premium.

Conflict-free: there is no conflict with social security, and accidental diseases are fully guaranteed.

legal ground

Social insurance law

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.