Suzhou social security card annual medical insurance

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The medical insurance rules of Suzhou Social Security Card are as follows

Outpatient clinic:

General outpatient medical expenses (excluding outpatient specific medical expenses) that meet the conditions of medical insurance settlement and payment shall be paid from personal account first. After the personal account is used up, in each settlement year (from April to March of the following year), employees (including flexible employees, "Xiebao" employees and those receiving unemployment insurance benefits, the same below) will be paid by the local supplementary medical insurance pooling fund in proportion within the prescribed limit (3,500 yuan for employees and 4,000 yuan for retirees), of which: in urban area B, the outpatient expenses incurred in urban hospitals and B-level retail pharmacies are 60% for employees.

Hospitalization:

1. Every time the insured is hospitalized, the medical expenses within the Qifubiaozhun shall be borne by the individual, and can also be offset by the balance of the previous year's personal account.

(1) The Qifubiaozhun for the first hospitalization of the insured within the settlement year (April of that year to March of the following year) is determined according to the different levels of hospitals, that is, hospitals above the municipal level: employees (including flexible employees, "co-insured" personnel, employees receiving unemployment insurance benefits who participate in employee medical insurance, the same below) 800 yuan and retirees 600 yuan; District (county) level hospitals and specialized hospitals: 600 yuan, an on-the-job employee, and 400 yuan, a retiree; Township hospitals: 300 yuan, an on-the-job worker, and 200 yuan, a retiree.

(2) The Qifubiaozhun for the second hospitalization in that year is 50% of the Qifubiaozhun for the first time; Qifubiaozhun for the third and above hospitalization is 100 yuan.

(3) If the patient has been hospitalized continuously for more than 180 days, the hospitalization settlement shall be made once every 180 days, and the part exceeding 180 days shall be treated as re-hospitalization.

(4) There is no threshold for the hospitalization expenses of the insured who are hospitalized for mental illness in Guangji Hospital, Psychiatric Welfare Institute and Taicang Ankang Hospital in this city, which meet the requirements of medical insurance settlement.

2. In the settlement year, after the expenses incurred in each hospitalization are calculated according to the regulations, the rest will be directly entered into the settlement part of the corresponding medical insurance fund according to the accumulated expenses of specific items of hospitalization and outpatient service in that year: the part below 40,000 yuan will be settled according to the proportion of 90% of employees and 95% of retirees; The part exceeding 40,000 yuan shall be settled by 95%.

3 each settlement year, the insured inpatient and outpatient specific projects accumulated within 200 thousand yuan, paid by the basic medical insurance fund in accordance with the provisions; The cost of more than 200 thousand yuan shall be paid by the social welfare fund of large medical expenses according to the regulations.