First, the proportion of reimbursement of medical insurance expenses for urban workers
Proportion of reimbursement for basic medical insurance for urban workers
Insured status, retired on the job, under 70 years old and over 70 years old, outpatient deductible line 1800 yuan reimbursement 1300 yuan.
? proportion
70% under 20,000 yuan (90% reimbursed by community hospitals) 85% (90% reimbursed by community hospitals) 90% above 20,000 yuan, 60%80% hospitalized for the first time in a natural year1.After 300 yuan, the deductible line of tertiary hospitals is-85% for each 650 yuan overall fund (the maximum payment limit is 6,543,800 yuan in a natural year). 2. Compensation ratio and policies for over-transfer of land acquisition personnel.
(1) The reimbursement rate is the same as that of urban workers.
(2) Outpatient medical treatment is based on the first consultation system at the grass-roots level. After the social security card is inserted into the designated medical institutions at the grass-roots level for referral, it can be reimbursed in real time to hospitals and designated medical institutions such as Class A (our hospital is a designated medical institution), traditional Chinese medicine and specialties. The maximum recommended validity period is 180 days.
Third, the proportion and policy of reimbursement for urban and rural residents
According to the document requirements of the Notice of Beijing Municipal People's Government on Printing and Distributing the Measures for Basic Medical Insurance for Urban and Rural Residents in Beijing (J.F.Z. [2065438+07] No.29) and the Notice of Beijing Municipal Bureau of Human Resources and Social Security on Printing and Distributing the Implementation Rules for the Measures for Basic Medical Insurance for Urban and Rural Residents in Beijing (J.S.B.S.No.250),
(1) Outpatient reimbursement ratio: deductible lines are calculated for hospitals below level 1 and hospitals above level 2 respectively.
The deductible line of hospitals below the first level is above the second level 100 yuan. The proportion of 550 yuan is 55% and 50%. The capping line is 4,500 yuan (2) The proportion of hospitalization reimbursement:
300 yuan 800 yuan 1300 yuan Hospital 80%78%75% top line 250,000 Note: urban and rural medical insurance patients in our hospital 1: the deductible line for students and children is halved (650 yuan), and other personnel are the first time in one year 1300 yuan, and then 650 yuan.
Note 2: The reimbursement rate for hospitalization in tertiary medical institutions such as district hospitals and district Chinese medicine hospitals is 78%.
(three) urban and rural elderly and working-age residents to implement the first diagnosis system. After the social security card is inserted into a designated medical institution at the grass-roots level or at the district level, it can be used for real-time reimbursement in the hospital of one's choice and designated medical institutions such as A-class, traditional Chinese medicine and specialties (our hospital is a designated medical institution of A-class). The maximum recommended validity period is 180 days.
(4) Special diseases of urban and rural residents shall be managed according to the measures for urban workers.
(5) The maternity expenses of urban and rural residents shall be implemented according to the maternity insurance policy.
Four. Compensation categories and general compensation standards
Medical charges (drugs, diagnosis and treatment items and service facilities) can be divided into three categories according to the categories of medical insurance reimbursement.
Drugs: "Class A" drugs refer to drugs that can be fully reimbursed, while "Class B" drugs refer to drugs that are partially borne by individuals and the rest are included in the scope of reimbursement, and the personal burden is mostly 10%. Class C drugs refer to drugs that are not covered by medical insurance reimbursement and need to be paid in full by themselves.
For drugs purchased centrally by the state, for drugs with the same generic name whose price is higher than the selected price, individuals need to pay 10% first, and then reimburse them in proportion; For generic drugs that fail the conformity evaluation, the payment standard is not higher than the price of the selected drug in principle.
Examination and treatment (single item >; 200 yuan): Individuals who pay 8% for color Doppler ultrasound, echocardiography, CT, magnetic vibration and ECT will be included in the reimbursement.
Valuable materials (single item >); 1000 yuan): pay 20% first and then be included in the reimbursement. (Effective from 2023 1