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根据《关于做好城镇职工基本医疗保险大额医疗费补充保险有关工作的通知》精神,从2013年1月1日起,我县调整了城镇职工基本医疗保险大额医疗费用补充保险起付线:职工基本医疗保险最高支付限额由原来5万元调整到8万元,保额由原15万元调整到22万元。超过最高限额的合规医疗费用在扣除个人先行支付的合规医疗费用6000元后由承保商业保险公司分两段赔付,第一段赔付比例由原来80%调整到85%,实际赔付由原来8万元调整到12万元;第二段赔付比例由原来85%调整到90%,实际赔付由原来7万元调整到10万元。
According to the spirit of “Notice on Doing Well the Supplementary Insurance of Large Medical Expenses for Basic Medical Insurance for Urban Employees”, from January 1, 2013, our county has adjusted the basic medical insurance for urban workers to cover the large amount of medical expenses and supplement the insurance starting line : The basic medical insurance employees maximum payment limit from 50000 yuan to 80000 yuan, the insured amount from 150000 yuan to 220000 yuan. More than the maximum amount of compliance medical expenses after deducting individual compliance paid for compliance medical costs 6,000 yuan by the underwriting commercial insurance company paid in two sections, the first paragraph of the proportion of 80% from 85% adjusted to the actual payment of the original 8 10,000 yuan adjusted to 120,000 yuan; the second paragraph 85% of the proportion of compensation adjusted to 90%, the actual payment from the original 70,000 yuan to 100,000 yuan.