In 2022, the individual payment standard for urban and rural residents will be 320 yuan.

Second, the enjoyment of treatment

The basic medical insurance benefits for urban and rural residents include general outpatient medical treatment, outpatient medical treatment for chronic diseases, medical treatment for serious diseases and hospitalization medical treatment.

1, general outpatient service.

In 2022, there is no deductible line for the general outpatient medical expenses incurred by insured residents in the designated medical institutions, and the reimbursement ratio is 60%. The cumulative maximum payment limit during a treatment enjoyment period is 360 yuan per person; The insured residents who are included in the coverage of "two diseases" have no deductible for outpatient medication of "two diseases", and the reimbursement ratio is 60% within the policy scope of township medical institutions (community health service centers) and village medical institutions, and the cumulative maximum payment limit during a treatment enjoyment period is 200 yuan per person. The original personal (family) account balance is not clear, and can continue to be used in designated medical institutions.

2. Outpatient chronic diseases.

At present, there are 27 chronic diseases in Anyang basic medical insurance outpatient department, namely: malignant tumor; Viral hepatitis C; After organ transplantation; Tuberculosis; Severe mental disorder; After heart valve replacement; After heart bypass surgery; After stent implantation; Sequela of acute cerebrovascular disease; Coronary atherosclerotic heart disease; Hypertension (one of the complications of heart, brain and eye); Diabetes (complicated with infection or one of the complications of heart, brain and eye); Chronic obstructive emphysema; Chronic heart failure; Cirrhosis; Systemic lupus erythematosus (one of cardiovascular, pulmonary, renal and neurological complications); Myasthenia gravis; Rheumatoid arthritis; Ankylosing spondylitis; Chronic renal insufficiency (including renal complications of hypertension and diabetes); Pulmonary interstitial fibrosis; Epilepsy; Parkinson's disease; Chronic glomerulonephritis; Nephrotic syndrome; Retinal vein occlusion; Children with cerebral palsy (rehabilitation). Insured residents suffering from the above diseases can go to the designated medical institutions for treatment of chronic diseases after passing the identification of chronic diseases. There is no deductible for outpatient medical expenses that meet the requirements, and the proportion of overall fund payment is 70%.

3. Serious and serious diseases.

There is no qifubiaozhun for medical expenses incurred by insured residents who meet the standards of serious diseases in our province and city. There are 33 kinds of inpatients with serious and serious diseases, and the medical expenses within the price limit standard are paid by the basic medical insurance fund in proportion, with the payment ratios of 80% for county-level medical institutions, 70% for municipal medical institutions and 65% for provincial medical institutions; There are 7 kinds of outpatient diseases with serious diseases and 93 kinds of outpatient specific drugs. The outpatient medical expenses that meet the requirements within the quota standard are included in the payment scope of the basic medical insurance pooling fund, and the payment ratio is 80%.

4. Hospitalization.

14 years of age (including 14 years of age) insured residents Qifubiaozhun halved. Other insured residents are hospitalized in hospitals at or above the county level (including the county level) for the second time and later, and the Qifubiaozhun is halved.

Pregnant women who participate in urban and rural residents' medical insurance give birth in hospital, and the hospitalization medical expenses are paid in a fixed amount. The quota standards are: natural delivery in 600 yuan, cesarean section 1600 yuan.

Maximum payment limit: the annual maximum payment limit of the basic medical insurance pooling fund is150,000 yuan.

5. Serious illness insurance.

After the insured residents' hospitalization medical expenses (including the medical expenses of outpatient chronic and special diseases, outpatient specific drugs, etc. with limited price and settlement) in an insurance year are reimbursed by the basic medical insurance, the part of the medical expenses within the policy scope of personal burden that exceeds 1. 1 10,000 yuan shall be reimbursed by the serious illness insurance funds according to the following proportion: 1. 1. /kloc-more than 0/00000 yuan, according to the proportion of 70% reimbursement.

Maximum payment limit: the maximum payment limit for serious illness insurance in the year is 400,000 yuan.

6. Direct settlement for medical treatment in different places.

Long-term residents in different places and long-term migrant workers can apply to the medical insurance agency in the insured place for filing in different places through on-site telephone, WeChat WeChat official account and other channels. After filing, the medical expenses incurred in the hospitalization of designated medical institutions in different places of residence (work place) can be directly settled through networking.

After the referral and referral procedures are issued by the designated medical institutions with the qualification of referral and referral in this city, they can be filed in the way specified by the medical insurance agency in the insured place, which can realize the direct settlement of the designated medical institutions in different places.

Failing to go through the procedures of referral, transfer and medical treatment in different places (except for emergency and mental illness), the proportion of reimbursement at the corresponding medical institution level will be reduced by 20 percentage points.

legal ground

Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers

Article 1 These Regulations are formulated in accordance with the relevant provisions of the state and the actual situation of this province in order to ensure the basic medical care for urban employees and make rational use of medical resources.

Article 2 The following units in cities and towns in this province and their employees must participate in the basic medical insurance in accordance with these regulations:

(1) Enterprises and their employees;

(2) Organs, institutions, intermediaries, social organizations, private non-enterprise units and their employees;

(three) the employing units of the troops and their employees without military status.

These Regulations shall apply to the retirees of the above-mentioned units.

Article 3 The basic medical insurance fund for urban employees shall be established, and the system of combining individual medical accounts (hereinafter referred to as individual accounts) with basic medical pooling funds (hereinafter referred to as pooling funds) shall be implemented.

The ownership of an individual account belongs to the individual. The ownership of the overall fund belongs to all personnel participating in the basic medical insurance.

Article 4 The basic medical insurance premium shall be borne by both the employer and the employees.

Fifth basic medical insurance in principle to the city, county, autonomous county as a whole unit, the implementation of territorial management.

Article 6 The basic medical insurance premium shall be collected by the local tax authorities of this province (hereinafter referred to as the collection authorities).