One is to guarantee the individual pays part in the basic medical insurance coverage, focusing on the expenses in the medical insurance catalogue for hospitalization and outpatient treatment of special diseases and the expenses for using the "dual-channel" drugs negotiated by the state. After the basic medical insurance is guaranteed, the individual pays more. The deductible for this responsible year is 654.38+00000 yuan, "deductible 0-654.38+000000 yuan" is 65%, "excess deductible 654.38+0000000 yuan" is 77%, and the maximum compensation is 654.38+000000 yuan.
The second is to protect the part outside the basic medical insurance coverage. Focus on ensuring the reasonable and necessary out-of-pocket expenses for the treatment of special diseases in inpatient and outpatient departments, including out-of-pocket drugs and high-value medical consumables, and effectively reduce the burden of out-of-pocket expenses for patients. The annual deductible for this responsibility is 20,000 yuan. "Deductible 0 to 6,543.8+ten thousand yuan" pays 55%, "excess deductible 6,543.8+ten thousand yuan" pays 67%, and the maximum compensation is 6,543.8+ten thousand yuan.
The third is the reinsurance part of serious and serious diseases. In order to effectively reduce the heavy burden of medical expenses for patients with serious and serious diseases, personal medical expenses are paid after the above two security responsibilities (including deductible 1 0,000 yuan and 20,000 yuan, including out-of-pocket expenses and total out-of-pocket expenses). The deductible amount of this guarantee liability is 50,000 yuan, the compensation ratio is 45%, and the maximum compensation amount is 6,543,800 yuan.
Fourth, some special serious diseases should be supplemented with the responsibility of protection. According to the contract, the product will provide supplementary protection for some special and major diseases, further reducing the high cost burden of related patients.
: What is insurance?
1. Insurance refers to the commercial insurance behavior that the applicant pays the insurance premium to the insurer in accordance with the contract, and the insurer assumes the responsibility for the property losses caused by possible accidents in accordance with the contract, or the insured assumes the liability for compensation. In case of death, disability, illness or reaching the age, term and other conditions agreed in the contract, the insurance money shall be paid.
2. From the perspective of economics, insurance is a financial arrangement to share unexpected losses; From the legal point of view, insurance is a contractual act, a contractual arrangement in which one party agrees to compensate the other party for losses; From a social point of view, insurance is an important part of the social and economic security system and a "subtle stabilizer" for social production and social life; From the perspective of risk management, insurance is a method of risk management.