1, medical insurance for urban workers. Qifubiaozhun varies according to the level of medical institutions. Level 1 medical institution 100 yuan, level 2 400 yuan, level 3 600 yuan. There is no deductible line for the poverty-stricken people who support the poor and the minimum living guarantee, etc., who are hospitalized in the first-and second-level designated medical institutions. The reimbursement rate varies according to the level of medical institutions, which is 90% for level I, 80% for level II and 60% for level III.
2. Medical insurance for urban residents. The upper limit of qifubiaozhun for first-class hospitals is uniformly adjusted to 100 yuan, for second-class hospitals in 300 yuan and for third-class hospitals in 700 yuan. The reimbursement rate of hospitalization expenses should reach about 70%, and the maximum payment limit should be 6 times of the annual per capita disposable income of local urban residents, and not less than 50 thousand yuan.
Gansu medical insurance reimbursement process:
1, hospitalization procedures. When patients go through hospitalization procedures, they need to show their ID cards and medical insurance cards and register for hospitalization to ensure that hospitalization expenses can be included in the scope of medical insurance reimbursement.
2. During hospitalization. The patient needs a diagnosis certificate issued by the attending physician, which will take effect after being stamped by the outpatient charge office; At the same time, you need a notice of hospitalization and a receipt of hospitalization deposit. When leaving the hospital, bring the above materials to the window for hospitalization procedures for discharge reimbursement.
3. Outpatient reimbursement. After an individual goes to the hospital for medical treatment or medicine purchase with a medical insurance certificate, if the expenses are above the deductible and within the annual reimbursement limit, the hospital will automatically settle the account according to the prescribed reimbursement ratio. When you buy medicine at a pharmacy, the pharmacy will automatically settle the expenses that should be reimbursed.
4. reimbursement for medical treatment in different places. For medical treatment in different places, you need to prepare discharge summary, expense invoice, medication list and other materials, as well as ID card, medical insurance card and medical treatment certificate in different places (if applicable). It is also necessary to issue a transfer certificate from the hospital where the medical insurance is located.
To sum up, the proportion of medical insurance reimbursement in Gansu Province varies according to different medical services and insured people. Insured people should understand the specific reimbursement ratio and related policies to ensure the rational use of medical insurance resources.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.