Lhasa medical insurance reimbursement ratio, Lhasa resident medical insurance reimbursement process, employee supplementary medical insurance payment ratio, Lhasa personal medical insurance payment ratio base, Lhasa designated medical institutions and pharmacies, rural cooperative medical care.
When participating in medical reimbursement, insured employees need to apply for outpatient special disease identification. After employees receive the "Lhasa Urban Employees Basic Medical Insurance Outpatient Special Disease Identification and Approval Form" from a designated medical institution and fill in the relevant content, the receiving doctor will fill in the diagnosis and treatment opinions, which will be confirmed by the attending physician of the designated hospital, and relevant examinations and tests will be attached. Please go to the political and labor department of your unit to verify the signature and seal, and the unit will submit it to the medical insurance agency for approval. After approval, insured employees can go to designated medical institutions for treatment with the approval form, medical insurance certificate, and medical insurance card, and enjoy outpatient treatment for special diseases. The approved treatment period for special outpatient diseases is 180 days, and the amount of medication should not exceed 15 days each time. For medical expenses that meet the identification standards for 20 special outpatient diseases and comply with the catalog stipulations, there is no deductible and the medical insurance coordinating fund will pay the insured employees at a ratio of 80%.
In addition, as long as you seek medical treatment and purchase medicines at designated designated medical institutions and designated retail pharmacies, and they are in compliance with the scope of the basic medical insurance drug catalog, the scope of basic medical insurance diagnosis and treatment items, and the basic medical insurance Basic medical insurance will pay for medical expenses incurred within the standard scope of medical service facilities in accordance with regulations. Among them, Class A drugs are fully reimbursed, and Class B drugs are first paid by the individual themselves for 10 days and then the rest is reimbursed. However, drugs not in the drug catalog will be fully borne by the individual. The reimbursement ratio for diagnostic and treatment equipment and medical materials that comply with basic medical insurance regulations is 98%. The maximum inpatient bed fee is determined by the hospital level, such as 80 yuan/day for a third-level hospital, 60 yuan/day for a second-level hospital, and 40 yuan/day for a first-level hospital.
However, service items such as registration fees and case fees, non-disease treatment items such as cosmetology and non-functional plastic surgery, diagnostic equipment and medical materials such as glasses and prostheses, and treatment items such as myopia orthopedics, etc. Basic medical insurance will not pay for the treatment of infertility (pregnancy) or various scientific research and clinical verification projects.
Xu Haiyuan, director of the Lhasa Municipal Labor and Social Security Bureau, said that last year, 36,033 urban residents in Lhasa participated in residents’ medical insurance. This year, the number of people participating in residents’ medical insurance reached 37,091. In the past two years, 1,462.48 yuan has been raised. Ten thousand yuan, including 2.7987 million yuan from individuals, 1.1803 million yuan from county-level financial subsidies, 3.2071 million yuan from municipal financial subsidies, and 7.4386 million yuan from autonomous region financial subsidies. "Currently, we have reimbursed 4.2025 million yuan for hospitalization medical expenses for 1,105 insured residents. The total cost is 7.0574 million yuan, and the average reimbursement rate of the overall fund is 60."
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