Huichang insurance reimbursement scope

Legal analysis: According to the Hainan Province basic medical insurance outpatient chronic special disease disease regulations, Alzheimer's disease, hyper and hypothyroidism, rheumatic and rheumatoid arthritis, epilepsy, hemophilia, and other 36 types of disease types can be reimbursed. 2, medical expenses within the scope of medical insurance 1 million. There are two kinds of cases. Case 1, small medical expenses within the scope of medical insurance: excluding the reimbursement by medical insurance, the individual's own portion within the scope of medical insurance, after deducting the annual deductible of 20,000 yuan, the remaining reimbursement will be made at a rate of 80%. Case 2, high medical expenses within the scope of health insurance: if the total expenses within the scope of health insurance exceed 450,000 (inclusive), regardless of the amount of reimbursement by health insurance, as long as the total expenses within the scope exceed, the part above 450,000 will be reimbursed in full. 3. 100,000 out-of-pocket drug expenses for hospitalization outside the scope of health insurance. After deducting the annual deductible of 20,000 for medicines used outside of social security during hospitalization, the remaining will be reimbursed at a rate of 50%. The out-of-pocket drug deductible here is not ****enjoyable with the liability two deductible above.

Legal basis: "The People's Republic of China *** and the State Regulations on Basic Medical Insurance for Urban Employees" Article 29 The medical fees for hospitalization for serious illnesses shall be paid in the following manner: (1) The starting standard shall be controlled, in principle, at the level of 9%-11% of the average annual social wage of the employees in the cities, counties and autonomous counties in the previous year. (b) The maximum payment limit is, in principle, controlled to be 3-5 times the average annual social wage of employees in cities, counties and autonomous counties in the previous year. (iii) Medical fees above the starting standard and below the maximum payment limit are mainly paid by the integrated fund, with individuals bearing a certain percentage. The proportion of medical expenses borne by retirees is appropriately taken care of. The scope of serious illnesses, the specific criteria for the starting standard and the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit to be shared shall be determined by the provincial people's government.