Proportion of reimbursement for rural cooperative medical care in Beihai City, Guangxi Province

Legal analysis: 1, outpatient reimbursement ratio. There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. Within a medical insurance year, there is no deductible for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed at the rate of 60%. The annual maximum personal payment limit of co-ordination fund is 400 yuan.

2. The proportion of hospitalization reimbursement. The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.