202 1 latest Wuxi medical insurance policy

Basic medical insurance for employees in Wuxi urban area

First, general outpatient service.

1, outpatient co-ordination: patients can see a doctor after signing a service agreement in a community hospital recognized by them, and their personal accounts can only be used up. The actual maximum amount you can enjoy each year is: 5,000 yuan for employees and 6,000 yuan for retirees, and the personal burden ratio of medical expenses in the system is 30% and 15% respectively. Sign up for the first consultation at the community health service center; Need to be transferred to other medical institutions, according to the needs of the disease from the contracted community health service center, after the referral procedures, transferred to medical institutions for medical treatment.

2. Outpatient chronic diseases: 12 Patients with chronic diseases (diabetes, hypertension (stage 2 and 3), malignant tumor, coronary heart disease, Parkinson's disease, chronic hepatitis, cerebral infarction, chronic bronchitis, chronic nephritis, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia): Go to the municipal hospital for identification first, and choose a medical institution (not a community health service center) that they think is convenient.

Persons under 70 years of age, individuals pay 800 yuan, medical insurance fund pays 70%, and the annual maximum payment limit is 3,500 yuan;

Retirees over 70 years of age, individuals pay 600 yuan, medical insurance fund pays 80%, and the annual maximum payment limit is 4,000 yuan.

Second, general hospitalization

1, hospitalization expenses according to regulations:

Third-level hospitals: medical expenses are more than 1 ,000 yuan (including 1 ,000 yuan) for the initial hospitalization expenses of third-level medical institutions after discharge, and 84% is paid by the on-the-job staff's overall fund and1.6% by individuals; Medical expenses 1 10,000 yuan to 40,000 yuan (including 40,000 yuan), 88% paid by the overall fund, and the individual pays 1.2% (the individual pays 50% of the above standard, the same below);

Hospitals below the second level: in the first and second level medical institutions, the medical expenses of employees are more than 654.38+00,000 yuan (including 654.38+00,000 yuan), 88% of which is paid by the overall fund and 654.38+02% by individuals; Medical expenses 1 0,000 yuan to 40,000 yuan (including 40,000 yuan), 90% paid by the overall fund, and 0/0% paid by individuals (50% paid by retirement);

Community hospital: discharged from the community health service center, the medical expenses are more than 40,000 yuan (including 40,000 yuan), 92% is paid by the overall fund, and 8% is paid by the individual (half of retirement pays);

2. Large expenses: the proportion of medical expenses above 40,000 yuan paid by the fund and paid by individuals is 92% and 8% respectively.

3. initial hospitalization fee: the first hospitalization fee (threshold fee) is required. The tertiary hospital is working in 950 yuan and retiring in 750 yuan; The second-level hospital is working in 750 yuan and retiring in 600 yuan. The first-class hospital is unified as 400 yuan, and the community health service center is unified as 300 yuan. During the year, the second hospitalization was 50% of the above standard, and the third and above hospitalization was 25% of the above standard.

Basic medical insurance for urban residents in Wuxi

First, general outpatient service.

1, 50% of patients go to the community health service center, and the limit is 1000 yuan (including individual contributions within the scope of medical insurance);

2, in the city and outside the hospital for medical treatment, 40% of the referral procedures, not for referral procedures according to the proportion of 50% of the implementation of referral.

Second, ordinary inpatients and mental patients.

1, the first visit should be in the community health service center. The qifubiaozhun for hospitalization medical expenses is 200 yuan, in which 90% of eligible medical expenses are paid by the fund and10% by individuals; Transferred to other medical institutions in the urban area, the initial hospitalization expenses for students and children are 300 yuan, and other residents are 600 yuan. If they are hospitalized in medical institutions below the second level, they will be paid according to 75% of the prescribed medical expenses, 25% for individuals, 65% for the funds of tertiary medical institutions, 35% for individuals, 55% for individuals transferred from the urban area, and 45% for individuals. If the transfer procedures are not handled according to the regulations, the fund will pay 50% of the above standards.

2. Maximum amount: the maximum amount of annual accumulated medical expenses for residents' basic medical insurance is 200,000 yuan. If the insured residents have paid for 5 years or more continuously, the maximum annual accumulated medical expenses will be increased by 50,000 yuan on this basis; The residents' medical insurance fund will no longer pay the part above the maximum annual accumulated medical expenses.

3, outpatient special disease treatment of medical expenses is 90%, the cost and general hospitalization medical expenses combined to calculate the annual maximum.

Serious illness insurance for urban and rural residents

First, ordinary inpatients and mental patients.

1, if the personal burden is between 1.8 million yuan and 50,000 yuan (including 50,000 yuan), the subsidy will be 50%;

2, personal burden in 50000 yuan -65438+ ten thousand yuan (including 65438+ ten thousand yuan), according to 60% subsidy;

3, personal burden of more than 654.38 million yuan, according to 80% subsidy;

4. In addition, every two years, the human and social departments in Xicheng will adjust and introduce new qifubiaozhun according to the annual per capita disposable income of urban residents in the previous year.