The coverage of resident medical insurance includes outpatient, two-disease drug protection, outpatient specific disease protection, hospitalization protection, medical assistance and serious illness insurance, etc., as follows:
If the insured person seeks medical treatment in a designated medical institution of medical insurance according to the regulations, he or she can enjoy the overall treatment of ordinary outpatient clinics in the corresponding year. For medical expenses within the scope of the policy, the proportion of payment within the scope of the general outpatient policy of resident medical insurance shall not be less than 50%.
When insured patients with hypertension and diabetes are treated in primary medical and health institutions, there is no minimum payment standard for the expenses within the scope of the "two diseases" drug policy, and the proportion of outpatient medical expenses for insured patients with hypertension and diabetes is not less than 50%. The "two diseases" are included in the scope of long-term prescription management of chronic disease outpatient clinics, and designated medical institutions may, in accordance with the principle of treating the disease and using drugs rationally, extend the amount of medical insurance medication for a single prescription to 12 weeks according to the needs of the condition, so as to reduce the number of times patients travel to and from medical institutions and the time of treatment.
If the insured suffers from the corresponding diseases of specific outpatient diseases, he or she can be diagnosed by qualified designated medical institutions and go through the qualification certification of specific outpatient diseases in accordance with the regulations, and can seek medical treatment in the outpatient clinic of the selected designated medical institutions.
Insured residents can enjoy reimbursement of hospitalization expenses when they are hospitalized in designated medical institutions**. The specific reimbursement ratio and maximum payment limit vary according to the level of the medical institution and the medical insurance policy.
After the inpatient and outpatient medical expenses for specific diseases incurred by the insured in a medical insurance year are paid by the basic medical insurance according to the regulations, the cumulative eligible medical expenses borne by the individual (including the medical expenses above the maximum payment limit of the basic medical insurance) reach the standard part of the critical illness insurance, which shall be paid by the serious illness insurance according to the regulations. The minimum payment standard shall not be higher than 50% of the per capita disposable income of residents in each city in the previous year, and the payment ratio shall not be less than 60%. For the needy groups that meet the regulations, the minimum payment standard for critical illness insurance will be lowered, and the payment ratio will be increased, and there will be no annual maximum payment limit.
After the basic medical insurance and serious illness insurance are paid, the eligible medical expenses borne by the individual shall be provided with assistance in accordance with regulations.
To sum up, the content of the 380 yuan protection of the resident medical insurance includes outpatient, two-disease drug protection, outpatient specific disease protection, hospitalization protection, medical assistance and serious illness insurance, etc., I hope the above content will help you!