1. Bed fee (up to 12 yuan/day for township health centers, and up to 15 yuan/day for municipal and above municipal medical institutions);
2. Drug fee (the scope of use of the drug is implemented in the drug catalog stipulated by the province);
3. Inspection fee (inspection, laboratory tests, etc., with a limit of 600 yuan);
4, Treatment fee (up to 300 yuan to be settled on the basis of the actual amount, 300 yuan or more part of the
I. The reimbursement of the cost items are:
1. Bed fee (up to 12 yuan/day in township health centers, and up to 15 yuan/day in municipal and above municipal health care institutions);
2. Drug fee (the scope of the use of medicines in accordance with the drug catalog stipulated by the provincial regulations);
3. Inspection fee (inspection, laboratory tests, etc., up to a limit of 600 yuan);
4, treatment costs (up to 300 yuan to be settled according to the actual situation, 300 yuan or more part of the reimbursement of 50% into the scope of reimbursement);
5, surgical fees (in accordance with the prescribed fees);
6, blood transfusion costs (surgical or salvage, up to a maximum limit of 500 yuan per hospitalization);
7, material costs ( Maximum limit of RMB 2,000 per hospitalization);
8. Outpatient expenses for radiotherapy, chemotherapy and dialysis for renal failure of patients with various tumors will be compensated as if they were inpatient expenses.
The proportion of reimbursement
After eliminating the non-reimbursable expenses, the reimbursable expenses are discounted according to the level of the medical institutions: 100% for township health centers in the city, 90% for municipal hospitals in the city, 80% for hospitals outside the city, and 60% for those without referral certificates. The discounted fees are settled proportionally by sections: 45% for up to RMB 4,000; 55% for RMB 4,001-8,000; 65% for RMB 8,001-12,000; 75% for RMB 12,001-20,000; and 80% for more than RMB 20,000. The maximum reimbursement amount per person per year is not more than 30,000 yuan.
Third, what materials are needed for reimbursement of medical expenses? What are the formalities and procedures
(a) the required materials are:
1, the original hospitalization invoice;
2, discharge records;
3, the list of medical expenses or doctor's orders (provided by the hospital);
4, my identity card (copy of ID card or proof of domicile);
5, other (referral certificate, proof of part-time job, etc.).
(2) procedures and processes
Patients in the city, directly in the designated medical institutions to settle hospitalization costs; transfer of hospitalization costs outside the city, within one month of the above materials to the township health center (co-management) for the settlement of procedures, after the first review, the township centralized to send to the municipal health insurance settlement.
Four, hospitalization is required to apply for approval or registration procedures?
Participants do not need to go through any formalities for hospitalization in the designated medical service institutions (health centers) in the city. However, if their condition requires them to be transferred out of the city for treatment, the treating doctor will fill in the diagnosis of their condition and the medical insurance office of the medical institution will approve it. It will be reported to the municipal cooperative management office for record. Emergency treatment within ten days in accordance with the prescribed procedures.
Fifth, how to reimburse the medical expenses of people who work outside the home
Working outside the home hospitalization, in addition to hospitalization invoices, discharge records, medical expense lists (or doctor's orders), proof of identity, but also need to provide proof of working place of work (can be provided by the neighborhood committee of the place where you work, or factories and other units). Otherwise, the settlement will be based on the proportion of no referral certificate.
Legal basis:
The People's Republic of China*** and the State Social Insurance Law
Article 28 meets the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.
Article 30 The following medical expenses are not included in the scope of payment of the basic medical insurance fund:
(1) those that should be paid out of the Workers' Compensation Insurance Fund;
(2) those that should be borne by a third party;
(3) those that should be borne by the public ****health;
(4) those that are sought outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.