How is the basic medical insurance graded? What's the difference between grade one, grade two and grade three?

Medical insurance is divided into three grades: basic medical care level 1, basic medical care level 2 and basic medical care level 3, and its payment, treatment and adaptation to the crowd are different.

First, the principle of medical treatment

1. First-class insured: see a doctor at any designated medical institution in the city.

2. Class II insured persons: outpatients seek medical treatment in the binding community health center, hospitalized in any designated medical institution in the city, and seriously ill outpatients seek medical treatment in specified medical institutions.

3. Three-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.

Second, pay the fee?

1, basic medical care (unit 6%+ individual 2%)+ local supplementary medical care (unit 0.2%)+ maternity medical care (unit 0.5%), the payment base is the employee's actual payment salary (minimum 3 13 1 yuan), and the total payment is 272 yuan;

2. The second payment base of basic medical care (unit 0.5%+ individual 0.2%)+ local supplementary medical care (unit 0. 1%)+ maternity medical care (unit 0.2%) is the average monthly salary of employees in the previous year (now 52 18), and the accumulated payment is 52;

3. The third basic medical care (unit 0.4%+ individual 0. 1%)+ local supplementary medical care (unit 0.05%), the payment base is the average monthly salary of employees in the previous year (now 52 18), and the total payment is 29 yuan.

Third, general outpatient treatment

1. Class I enrollment: Personal account is used to pay medical expenses within the scope of the insured's general outpatient medical insurance catalogue. 70% of the basic medical expenses of hospitals are paid by individual accounts, and 30% are paid by the overall fund according to regulations.

2. Second Insured/Third Insured:

(1) belongs to Class A drugs and Class B drugs, which are paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively;

(2) 90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment amount shall not exceed 120 yuan;

(three) the total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-and third-class insured person in a medical insurance year shall not exceed 1 000 yuan.

Iv. Personal account family * * *

1. Class I insured: the accumulated amount of personal account exceeds 5% of the average salary of employees in this city in the previous year, and the excess part can be purchased at the over-the-counter pharmacies within the scope of the medical insurance catalogue; I, my spouse and immediate family members can pay for the basic medical insurance in this city.

The basic medical expenses and local supplementary medical expenses paid by the designated medical institutions; You can pay the health check-up and vaccination fees for yourself, your spouse and immediate family members who participate in the basic medical insurance in this city.

2. Secondary Insured/Tertiary Insured: None. You can't swipe your social security card when you go to the drugstore to buy medicine.

5. Personal account is insufficient to pay.

1. Class I insured persons: those who have been insured continuously for one year, and the basic outpatient medical expenses and supplementary medical expenses paid by themselves account for 5% of the average salary of supermarket employees in the same medical insurance year, 70% of the excess will be paid by the overall fund according to regulations (80% for those over 70 years old).

2. Secondary Insured/Tertiary Insured: None.

Six, outpatient large equipment inspection and treatment costs

1. First-class insured: 80% shall be paid by the overall fund as required.

2. Second-level insured/third-level insured: the highest unit price of general medical treatment items shall not exceed 120 yuan.

Seven, general outpatient blood transfusion costs

1. First-class insured: 90% shall be paid by the overall fund as required.

2. Second-level insured/third-level insured: 70% shall be paid by the overall fund as required.

Eight, outpatient treatment of serious illness

First-class insured/second-class insured/third-class insured: 60%-90% will be paid by the overall fund according to the continuous insurance years.

Nine, hospitalization

1. First-class insured: 95% or 90% of the basic medical expenses incurred in hospitalization and supplementary medical expenses above the deductible line shall be paid according to the regulations.

2. Second Insured/Third Insured:

(1) can be hospitalized in the settlement hospital bound by the social rehabilitation center, or can be referred to the specified hospital through the settlement hospital. The reimbursement ratio of basic medical expenses and local supplementary medical expenses above hospitalization deductible line is: first-class hospital: 85%; Secondary hospitals: 80%; Tertiary hospitals: 75%

(2) Those who have not been referred to a hospital other than the settlement hospital shall be paid 90% of the hospitalization payment standard of the hospital (that is, the payment standard in the above 1).

X. seeking medical treatment outside the city

1. First-class insured: general outpatient expenses, serious illness outpatient expenses and hospitalization expenses can be reimbursed according to regulations.

2. Secondary insured/tertiary insured: general outpatient expenses will not be reimbursed; In accordance with the provisions of the serious illness outpatient expenses and hospitalization expenses can be reimbursed according to the provisions.

Note: the policy will change from time to time. Please refer to the latest policy.