What is the basic social security coverage

One of the social insurance programs

includes: basic medical insurance, basic pension insurance, unemployment insurance, work injury insurance, maternity insurance

Usually, the three insurance and one gold: basic medical insurance, basic pension insurance, unemployment insurance, provident fund

Commonly known as the so-called social security: basic medical insurance, basic pension insurance, unemployment insurance

The basic medical insurance of social security

1, the scope of coverage: general outpatient disease, hospitalization, outpatient specific items

* Outpatient specific items are: severe uremia in the outpatient dialysis treatment, malignant tumors in the dialysis treatment in the outpatient clinic, kidney transplantation in the outpatient clinic after the anti-rejection treatment, in the second and third tiers of the hospital Treatment for emergency inpatient observation, and treatment at home beds opened in first-class hospitals or primary healthcare organizations.

2, the reimbursement provisions:

(1) the starting line provisions: active employees retired employees

first-class hospitals 500 yuan 350 yuan

second-class hospitals 1,000 yuan 700 yuan

third-class hospitals 2,000 yuan 1,400 yuan

that is,: sick in the third-class hospitals, treatment, spending no more than 2,000 yuan, the social security will not be reported, all out-of-pocket payments.

(2) reimbursement ratio regulations: active employees retired employees

90% of the first hospital 93%

85% of the second hospital 89.5%

80% of the third hospital 86%

that is: sick in the third level of hospital treatment, costing more than 2,000 yuan, then the social security report 80%, 20% out-of-pocket.

(3) critical illness benefit provisions:

A. Social security does not have a range of serious illnesses, according to the actual cost of medical expenses used to classify serious illnesses and common diseases.

B. Dividing the standard that the starting line for serious illnesses: four times the average annual salary of the city workers in the previous year, at the current level of about 150,000 yuan, that is, hospitalization medical expenses exceeded 150,000, is included in the scope of social security coverage of serious illnesses.

C. For expenses up to 150,000 RMB, the reimbursement will be based on general medical care; for expenses above 150,000 RMB and up to 100,000 RMB, the reimbursement will be 90% of the 100,000 RMB, and 10% will be paid out of pocket; for expenses above 250,000 RMB and up to 50,000 RMB, the reimbursement will be 95% of the 50,000 RMB, and 5% will be paid out of pocket. The social security coverage for critical illnesses is capped at 150,000 dollars.