The reimbursement ratio of Zhengzhou Employee Medical Insurance varies according to different levels of medical institutions and whether you are employed. The following is the specific reimbursement ratio:
Outpatient reimbursement ratio:
The minimum overall payment standard for general outpatient clinics is 40 yuan per time. Township health centers and community health service centers do not have such a minimum payment standard. Pay standard.
Grade 3A designated medical institutions? The payment ratio for outpatient medical treatment is 55%.
The payment ratio for outpatient medical treatment in designated medical institutions at the provincial, municipal, and county levels is 60%.
The payment ratio for outpatient treatment in township hospitals and community health service centers is 65%.
Hospitalization reimbursement ratio:
The minimum payment standard for hospitalization in designated hospitals at the township level (township health centers, community health service agencies) is 200 yuan, and the reimbursement ratio is 95.
The minimum payment standard for hospitalization in designated hospitals at the county level (level one, level two, level three), city level (level two), and provincial level (level one) is 300 yuan, and the reimbursement ratio is 95.
The minimum payment standard for hospitalization in designated hospitals at the municipal level (third level) and provincial level (secondary level, third level non-A, etc.) is 600 yuan, and the reimbursement ratio is 90.
The minimum payment standard for hospitalization in provincial (third-level A-level) designated hospitals is 900 yuan, and the reimbursement ratio is 88.
Critical illness reimbursement:
The reimbursement ratio for serious and extremely serious illnesses in Zhengzhou’s urban employee medical insurance is 85%.
Hospitalization reimbursement ratio for retired employees:
The minimum payment standard for hospitalization in designated hospitals at the township level (township health centers, community health service agencies) is 200 yuan, and the reimbursement ratio is 97.
The minimum payment standard for hospitalization in designated hospitals at the county level (level one, level two, level three), city level (level two), and provincial level (level one) is 300 yuan, and the reimbursement ratio is 97.
The minimum payment standard for hospitalization in designated hospitals at the municipal level (third level) and provincial level (secondary level, third level non-A, etc.) is 600 yuan, and the reimbursement ratio is 95.
The minimum payment standard for hospitalization in provincial (three-level A-level) designated hospitals is 900 yuan, and the reimbursement ratio is 93.
Outpatient medical insurance reimbursement process and precautions:
You need to bring the following information when reimbursing:
1. Original ID card or social security card;
2. Original disease diagnosis certificate issued by a specialist at a designated medical institution;
3. Original outpatient medical records, examinations, test result reports and other medical information;
4 .Original outpatient fee receipt from a unified financial and taxation medical institution;
5. A detailed list of outpatient fees printed from the hospital computer or the original payer's prescription issued by a doctor;
6. Designated pharmacies: The original copy of the unified invoice for the sale of tax commodities and the computer printed list;
7. If you are handling it on behalf of someone else, you need to provide the original ID card of the agent.
Bring all the above information to the relevant departments of the local social security center to apply. After review, if the information is complete and the conditions are met, the application can be processed immediately. When the applicant applies for outpatient medical expense reimbursement, the amount transferred to the medical insurance personal account in the current social security year will be deducted first, and then the reimbursement amount will be determined.
In summary: Urban employee medical insurance is coordinated at the municipal level, with unified policies, unified standards, and unified handling procedures throughout the city.
Legal basis:
"Social Insurance Law of the People's Republic of China"
Article 2
The state establishes basic pension insurance , basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurance systems to protect citizens’ rights to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.
Article 17
If an individual who participates in basic pension insurance dies due to illness or non-work-related reasons, his or her surviving family members may receive funeral subsidies and pensions; if the individual has not reached statutory retirement Those who completely lose their ability to work due to illness or non-work-related disability when they are old may receive sick and disability allowances. The required funds are paid from the basic pension insurance fund. .
Article 26
The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.
Article 28
Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be deducted from the basic medical insurance fund in accordance with national regulations. Pay.