What is the reimbursement rate of health insurance in 2017
Hospitalization health insurance reimbursement method
1, first of all, in the beginning of the hospitalization should be with the hospital to explain their own is the health insurance reimbursement, but to advance the medical expenses, and after that, you can take the invoice to go to the window of the settlement of the health insurance reimbursement.
2, with the health insurance card personal account to pay for hospitalization costs, in the discharge settlement before out to tell the hospital settlement staff, according to the normal credit card procedures can be processed. The self-pay program cannot be paid by the individual account of the medical insurance card.
3. The settlement of hospitalization expenses is based on the post-payment method for service items.
Medicare Reimbursement Ratio in 2017
I. Urban Medicare Reimbursement Ratio
Urban residents who are hospitalized more than two times in a billing year will no longer be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or are hospitalized for more than two times, the difference will be made up in accordance with the starting standard of the hospital to which they are transferred or to which they are re-admitted.
1. Students and children. For medical expenses under 180,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for tertiary hospitals is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for secondary hospitals is 300 RMB, with a reimbursement rate of 60%; and primary hospitals do not set a starting standard, with a reimbursement rate of 65%.
2. Aged 70 and above. For medical expenses under 100,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for Level 3 hospitals is 650 RMB, the reimbursement rate is 50%, and the upper limit is 2,000 RMB; the starting standard for Level 2 hospitals is 300 RMB, the reimbursement rate is 60%; and the reimbursement rate for Level 1 hospitals is 65% without setting a starting standard.
3. Other urban residents. In a billing year, the occurrence of the reimbursement of the scope of medical expenses under 100,000 yuan, three hospitals starting standard of 659 yuan, reimbursement rate of 50% of the upper limit of 2,000 yuan; two hospitals hospitalization starting standard of 300 yuan, the reimbursement rate of 55%; first-class hospitals do not set a standard of reimbursement, reimbursement rate of 60%.
Second, the employee health insurance reimbursement ratio
Generally speaking, different regions have different economic development, so the reimbursement ratio also varies, the following on the Beijing employee health insurance insurance ratio situation is explained.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1,800 RMB after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50 percent of the $700 portion is reimbursed, which is $350.
In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a 2009 year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is 650 yuan. And the maximum amount of payment from the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan of expenses, the employee pays 15%, that is, reimbursement of 85%; 30,000 yuan to 40,000 yuan of expenses, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the highest limit of payment of the portion of the expenses, then 95% of the expenses are reimbursed, the employee only needs to pay 5%. And retirees personally pay 60 percent of the rate for active (that is, the aforementioned) employees, but anything below the threshold is paid by the individual.
The diagnostic and therapeutic items that are not covered by the basic medical insurance for employees are mainly those that are not clinically necessary, those whose effects are uncertain, and those for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and others such as infertility treatments, and so on.
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