The scope and amount of repayment of mutual funds

The reimbursement scope of the medical mutual fund includes medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue, and are paid from the basic medical insurance fund in accordance with state regulations. Outpatient medical expenses: within the payment range of basic medical insurance (within the maximum payment amount from the deductible line to the capping line), the "self-pay one" part of the expenses borne by employees, after deducting the deductible line 1.08 million yuan, accounts for 20% (25% for model workers and extremely poor employees). Medical insurance for urban and rural residents insured in the outpatient co-ordination medical institutions (generally township hospitals and community health service centers) in line with the outpatient co-ordination payment within the scope of outpatient medical expenses, paid by the outpatient co-ordination fund according to the proportion of 60%, an insurance period reimbursement does not exceed 200 yuan. Medical mutual aid usually refers to medical mutual aid for serious illness, which is a social security system, mainly for urban workers. The insured suffers from a serious illness that exceeds the maximum payment limit of the basic medical insurance pooling fund, and can give medical assistance for serious illness through social medical mutual assistance. It can be seen that both medical mutual assistance and medical insurance belong to the category of social security, and they can complement each other to provide medical security for the insured for serious illness and minor illness. How to participate in the insurance, the payment standard is subject to the local social security policy. Medical mutual aid for serious illness refers to a social medical mutual aid system established by urban workers on the basis of participating in basic medical insurance to solve the problem that the insured patients exceed the maximum payment limit of the basic medical insurance pooling fund and ensure the medical needs of employees for serious illness.

Legal basis:

People's Republic of China (PRC) social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Measures for the implementation of medical assistance for serious and serious diseases in urban and rural areas

Second, the urban and rural medical assistance system is coordinated by the government and implemented by the civil affairs department; With the cooperation of health, finance and other departments, appropriate subsidies will be given to the medical expenses of rural five-guarantee households, rural low-guarantee households and urban low-guarantee households suffering from serious diseases according to certain standards to alleviate their poverty caused by illness.

The third is the principle of establishing urban and rural medical assistance system: the principle that the level of assistance is compatible with the level of economic and social development and the ability of financial payment; Principle of territorial management; The principles of unified system, standardized management, openness and fairness; Start with a low standard, rescue by classification, and promote as a whole; The principle of saving everything.