Proportion of reimbursement for multiple hospitalizations within one year

Medical expenses incurred in multiple hospitalizations within one year can be reimbursed according to local medical insurance policies as long as they are within the scope of medical insurance. The length of hospitalization will directly affect its cost. Therefore, the insured amount of this kind of insurance should be determined according to the average hospitalization expenses of patients. 400 yuan, the deductible line of the first-class hospital, the reimbursement rate is 90%; The deductible line of secondary hospitals is 800 yuan, and the reimbursement rate is 85%; The deductible line of tertiary hospital 1600 yuan, with the reimbursement rate of 80%. Employees are hospitalized twice a year for medical insurance, and the reimbursement rate within the scope of medical insurance is the same. Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different.

The medical expenses incurred in many hospitalizations in the middle of the year can be reimbursed according to the local medical insurance policy as long as they are within the scope of medical insurance. It is suggested that you directly consult the local medical insurance handling department or call the local social security consulting service hotline 12333 for consultation. Reimbursement scope: medical expenses: auxiliary examination: ECG, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, ct, nuclear magnetic resonance and other examination expenses 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan. When the medical expenses of employees and retirees for hospitalization, outpatient emergency rescue or outpatient treatment of some serious diseases exceed the "top line" of the overall fund within an insurance year, they shall be calculated by commercial insurance companies in sections.

The expenses within the scope of medical assistance reimbursement policy shall not be less than 70%. Through basic medical insurance, serious illness insurance, medical assistance and other health poverty alleviation policies, the proportion of hospitalization reimbursement for poor people has reached a certain moderate level, greatly reducing the burden of medical expenses for poor people.

Legal basis:

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.

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.