Medicare insurance reimbursement scope is very wide, medical expenses are generally in accordance with the characteristics of its medical services to distinguish, mainly contains the doctor's outpatient costs, drugs, hospitalization costs, nursing costs, hospital miscellaneous expenses, surgical costs, a variety of examination costs. Medical expenses are the costs incurred by the patient for the treatment of the disease, which includes not only the doctor's medical and surgical fees, but also the costs of hospitalization, nursing care, hospital equipment and so on.
Ratio and scope of reimbursement of medical insurance:
1. Outpatient and emergency medical expenses: the part of medical expenses exceeding 2,000 yuan in total within the annual period (January 1~December 31) of an active employee that is in line with the scope of basic medical insurance.
2. Settlement ratio: 50% reimbursement for the part of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.
3. Participants should keep the outpatient medical receipts (including receipts and prescription bottoms for the parts below the large amount) of the outpatient consultation at the designated hospitals as the vouchers for reimbursement of medical expenses.
4, three kinds of special disease outpatient medical treatment: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, renal transplantation to take anti-rejection drugs need to be in outpatient medical treatment, by the participant's second and third-class hospitals for medical treatment of the designated hospitals to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the regional medical insurance center for approval and filing. The form will be submitted to the district medical insurance center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
5. For inpatient medical care, the medical insurance payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement.
Turn left|Turn right
Expanded information
Medicare reimbursement ratio:
Urban residents who are hospitalized for more than two times in one billing year will no longer be charged for the cost of the starting standard from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the stipulated starting standard of the hospital to which they are transferred or re-admitted.
Students and children
For medical expenses under 180,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for a tertiary hospital is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for a secondary hospital is 300 RMB, with a reimbursement rate of 60%; and there is no starting standard for a tertiary hospital, with a reimbursement rate of 65%.
Over 70 years old and above
In a billing year, for medical expenses of less than 100,000 RMB incurred that meet the scope of reimbursement, the starting standard for tertiary hospitals is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; for secondary hospitals, the starting standard is 300 RMB, with a reimbursement rate of 60%; and for first-class hospitals, there is no starting standard, with a reimbursement rate of 65%.
Other urban residents
In a billing year, for medical expenses of less than 100,000 yuan that meet the scope of reimbursement, the starting standard for third-level hospitals is 659 yuan, and the reimbursement rate is 50% with an upper limit of 2,000 yuan; the starting standard for second-level hospitals' hospitalization is 300 yuan, and the reimbursement rate is 55%; and the reimbursement rate for first-level hospitals does not have a starting standard, and the reimbursement rate is 60%.