Nanchang employee health insurance reimbursement ratio
Outpatient reimbursement ratio:
1, a natural year of general outpatient emergency expenses incurred by the staff cumulative total of more than 2,000 yuan, more than 2,000 yuan of the part of the large medical solidarity fund to pay 50%, the individual out-of-pocket 50%.
2, retirees accumulated more than 1,300 yuan, 1,300 yuan or more of the part of the cloth over 70 years of age of the large medical mutual fund to pay 70% of the individual to pay 30%, 70 years of age and above the large medical mutual fund to pay 80%, the individual to pay 20%.
Hospitalization reimbursement rate:
The starting standard for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization.
Payment rate standards:
30,000 yuan, 85% in service, 91% for retirement; 30,000-40,000 yuan, 90% in service, 94% for retirement; over 40,000 yuan, 95% in service, 97% for retirement.
Nanchang workers' medical insurance reimbursement conditions
1, legal citizens of China;
2, pay medical insurance;
3, go to the designated hospital.
Nanchang workers health insurance reimbursement application materials
1, the hospital materials:
①Nanchang urban workers health insurance outpatient cost settlement summary table
②Nanchang urban workers health insurance special disease cost settlement summary table
③Nanchang urban workers health insurance Hemodialysis Costs Settlement Summary Form
④ Nanchang City Urban Workers' Health Insurance Post-transplantation Anti-Rejection Treatment Costs Settlement Summary Form
⑤ Nanchang City Urban Workers' Health Insurance Hospitalization Costs Settlement Summary Form
⑥ Participant's Hospitalization Costs Detailed List
2. Sporadic Reimbursement Materials:
①Financial official invoice
①Costs detailed list p>②Expense detail list
③Discharge summary
④Treatment determination certificate
⑤Special circumstances also need to be shown again to explain the report
Nanchang employee health insurance reimbursement process
1, unit operator to declare the cost of materials or participants in the report of sporadic reimbursement materials
2, fixed-point management section and the management section and the sporadic reimbursement materials
2, the fixed-point management section and treatment determination section acceptance
3, settlement audit
4, within one month to pay the expenses.
Expanded Information:
Medicare Reimbursement Scope
I. Scope of Diagnostic and Treatment Items for Which Basic Insurance Will Not Pay Fees
(I) Service Item Category
1, Registration Fee, Out-of-Hospital Consultation Fee, and Medical Record Costs, etc.
2, Visiting Fee, Expedited examination and treatment fee (except for emergency), surcharge for named surgery, quality and premium fee, fee for self-employed special nurses, and other special medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program as well as messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase the height of the project.
3, a variety of health checkups.
4, a variety of preventive, health care treatment programs.
5, dental orthodontics, dental porcelain.
6, a variety of medical consultation (excluding psychiatric consultation), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the inspection and treatment program
2, glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitative appliances.
3, a variety of self-use health care, massage, examination and rehabilitation and treatment equipment.
(D) therapeutic project category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues
3, myopic orthopaedics
4, qigong therapy, music therapy, health care nutritional therapy , magnetic therapy and other complementary therapeutic programs.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction treatment program
2, a variety of scientific research, clinical verification of the treatment program.
Basic medical insurance to pay part of the cost of the scope of treatment programs
(a) diagnostic and treatment equipment and medical materials
1, the application of X-ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), cardiography and angiography X-ray device (γ-knife, χ-knife). X-ray machine (including digital subtraction equipment), cardiac and angiographic X-ray machine, magnetic **** vibration imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment for the examination and treatment of the project;
2, extracorporeal shockwave lithotripsy and hyperbaric oxygen therapy
3, pacemakers, Artificial joints, artificial crystals, vascular stents in vivo replacement of artificial organs, in vivo placement of materials
4, the provincial pricing department of the disposable medical materials that can be charged separately.
(B) treatment project category
1, hemodialysis, peritoneal dialysis
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
(3) examination and treatment items of medical instruments and equipment and medical materials with a single cost of more than 400 yuan.
Baidu Encyclopedia-Basic Medical Insurance for Urban Workers