Hangzhou Xiaoshan social security medical cap line how much

Hangzhou Xiaoshan District employee medical insurance co-ordinated fund payment to set up a maximum limit, the maximum limit (calculated cumulatively based on the date of discharge from the hospital) is 240,000 yuan. Children's medical insurance and other urban and rural residents' medical insurance of the integrated fund payment to set up a maximum limit (calculated cumulatively based on the date of discharge), the maximum limit is 180,000 yuan; college students' medical insurance of the integrated fund payment does not set a maximum limit.

Employee Basic Medical Insurance

In a settlement year, the hospitalization medical fees incurred by the insured that are within the scope of the medical insurance expenses shall be settled as follows:

1. The maximum limit of payment by the co-ordination fund of the employee medical insurance is set at 240,000 yuan (calculated cumulatively based on the date of discharge from the hospital).

2. The starting standard of payment for a single hospitalization shall be borne as follows: RMB 800 for tertiary and corresponding medical institutions (hereinafter referred to as tertiary medical institutions), RMB 600 for tertiary and corresponding medical institutions (hereinafter referred to as tertiary medical institutions), and RMB 300 for other medical institutions and community health service institutions.

3. The proportion of medical fees above the starting standard and below the maximum limit to be borne by the Employees' Medical Insurance Coordination Fund is as follows:

More than the starting standard for hospitalization and up to 40,000 yuan (inclusive), 82% of medical fees incurred in tertiary medical institutions before retirement, 86% after retirement; 84% of medical fees incurred in secondary medical institutions before retirement, 88% after retirement; 86% of medical fees incurred in other medical institutions before retirement, 86% after retirement, 86% before retirement, 86% after retirement. medical expenses incurred in other medical institutions, 86% before retirement, 90% after retirement; medical expenses incurred in community health service organizations, 88% before retirement, 93% after retirement.

More than 40,000 yuan to 240,000 yuan (inclusive), medical expenses incurred in tertiary medical institutions, 88% before retirement, 94% after retirement; medical expenses incurred in secondary medical institutions, 90% before retirement, 95% after retirement; medical expenses incurred in other medical institutions and community health service organizations, 92% before retirement, 96% after retirement.

4. Part of the medical fees above the maximum limit of the integrated fund shall be borne by the medical subsidy fund for major diseases and individuals***, of which the proportion borne by the medical subsidy fund for major diseases shall be: 88% for tertiary medical institutions; 90% for secondary medical institutions; and 92% for other medical institutions and community health service institutions.

In a settlement year, the insured person occurs in line with the scope of health insurance spending on general outpatient medical fees Settlement according to the following provisions:

1. First by the individual account funds for the year, the individual account funds for the year is insufficient to pay the individual to bear an outpatient outpatient starting standard of medical costs. Specifically: 1,000 yuan for pre-retirement participants; 300 yuan for retirees of enterprises and reference enterprises; 700 yuan for other retirees.

2. Participants in the year of retirement outpatient outpatient starting standard is determined by the actual month before and after the review of health insurance retirement benefits were converted. If the actual outpatient starting payment standard paid by an individual in the current year has exceeded the payable portion, the exceeding portion will be transferred to the calendar year funds of his/her personal account at the rate of 80%.

3. The proportion of medical fees above the outpatient starting standard borne by the integrated fund is as follows: 76% of medical fees incurred in tertiary medical institutions before retirement, 82% after retirement; 80% of medical fees incurred in secondary medical institutions before retirement, 85% after retirement; 84% of medical fees incurred in other medical institutions before retirement, 88% after retirement; and 88% of medical fees incurred in community health service institutions before retirement, 88% after retirement. Medical expenses incurred in community health service organizations, 88% before retirement, 92% after retirement.

Basic Medical Insurance for Urban and Rural Residents

In a settlement year, the hospitalization medical fees incurred by the insured that are within the scope of the medical insurance expenditures shall be settled in accordance with the following provisions:

1. The integrated fund of the children's medical insurance and the other urban and rural residents' medical insurance establishes a maximum limit of payment (calculated cumulatively based on the date of discharge from hospitals), with a maximum of 180,000 yuan; the integrated fund of the college students' medical insurance does not have a maximum limit of payment. There is no maximum limit for the payment from the coordinated fund for university students' medical insurance.

2. The starting standard for one hospitalization is 800 yuan for tertiary medical institutions, 600 yuan for secondary medical institutions, and 300 yuan for other medical institutions and community health service institutions.

3. The proportion of medical fees above the starting standard to be borne by the integrated fund shall be paid in accordance with the following provisions:

(1) For children's and other urban and rural residents' medical insurance hospitalization above the starting standard up to 180,000 yuan (inclusive), the fund shall bear 70% of the medical fees incurred in tertiary medical institutions; 75% of the medical fees incurred in secondary medical institutions; and 75% of the medical fees incurred in other medical institutions and community health service institutions; the fund shall bear the medical fees incurred in other medical institutions and community health service institutions. The fund will bear 80% of the medical expenses incurred in other medical institutions and community health service organizations.

A portion of the medical fees above 180,000 yuan will be subsidized by the government at the rate of 70% by arranging medical subsidy funds for urban and rural residents with major diseases.

(2) College students' medical insurance hospitalization starting standard above to 180,000 yuan (including), in the third level of medical institutions incurred medical costs, the fund will bear 70%; in the second level of medical institutions incurred medical costs, the fund will bear 75%; in other medical institutions and community health service institutions incurred medical costs, the fund will bear 80%.

The fund pays 80% of the medical fees above 180,000 yuan.

In a settlement year, the general outpatient medical fees incurred by the insured persons which are in line with the scope of medical insurance expenditure shall be settled according to the following provisions:

1. Individuals shall first bear the medical fees of one outpatient outpatient outpatient starting standard, which shall be 300 yuan. Among them, other urban and rural residents of the first and second tranche of the medical insurance participants voluntarily choose to fixed-point in the residence of the community health service institutions, their outpatient medical fees are not set a starting standard.

2. The proportion of outpatient medical fees above the starting standard to be borne by the integrated fund is as follows:

(1) Participants in the children's and college students' medical insurance: 40% of medical fees incurred in tertiary healthcare institutions are to be borne by the fund; 50% of medical fees incurred in secondary healthcare institutions are to be borne by the fund; 70% of medical fees incurred in other healthcare institutions and community healthcare service organizations are to be borne by the fund. The fund will bear 70% of the medical fees.

(2) For other urban and rural residents' medical insurance participants in the first tier, the fund bears 40% of the medical fees incurred in third-tier medical institutions, 50% of the medical fees incurred in second-tier medical institutions, and 70% of the medical fees incurred in other medical institutions and community health service organizations. Other urban and rural residents of the second class of medical insurance participants: in the third level of medical institutions incurred medical costs, the fund bears 25%; in the second level of medical institutions incurred medical costs, the fund bears 35%; in other medical institutions and community health service institutions incurred medical costs, the fund bears 60%.