First, the medical insurance reimbursement expenses are:
1, bed fee (the highest is township hospitals 12 yuan/day, and municipal and above medical institutions 15 yuan/day);
2. Drug expenses (the scope of drug use shall be subject to the provisions of the provincial drug catalogue);
3, inspection fees (inspection, testing, etc. , limit 600 yuan);
4. Treatment expenses (settled according to the facts within 300 yuan, and 50% of the above parts in 300 yuan are included in the scope of reimbursement);
5. Surgery fee (charged according to regulations);
6. Blood transfusion fee (the maximum amount of surgery or rescue and hospitalization is in 500 yuan);
7, material costs (the maximum limit of 2000 yuan per hospitalization);
8, all kinds of tumor patients with radiotherapy, chemotherapy and renal failure need dialysis outpatient expenses, as hospitalization expenses for compensation.
Second, what is the reimbursement rate?
After excluding non-reimbursable expenses, the reportable expenses are discounted according to different levels of medical institutions: township hospitals in this city 100%, municipal hospitals in this city 90%, outside the city 80%, and 60% without referral certificate. After the discount, the expenses will be settled in proportion: 45% will be reimbursed within 4000 yuan; 400 1-8000 yuan will be reimbursed by 55%; 800 1- 12000 yuan will be reimbursed by 65%; 12001-20,000 yuan will be reimbursed by 75%; More than 20 thousand yuan will be reimbursed 80%. The maximum amount of compensation per person per year shall not exceed 30,000 yuan.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party; (three) shall be borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.