Reimbursement rate

Surgery fee limit of 50 yuan, prescription drug fee limit of 200 yuan; Tertiary hospital visit reimbursement of 20%, each visit each examination fee and surgery fee limit of 50 yuan, prescription drug fee limit of 200 yuan; Traditional Chinese medicine invoice attached to the prescription limit of 1 yuan per sticker; township cooperative medical outpatient reimbursement of 5,000 yuan per year limit [2]? Hospitalization Reimbursement scope: medication expenses, auxiliary medication expenses, and other expenses. Hospitalization Reimbursement scope: medicine: auxiliary examination: ECG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration, and other various examination fees limit 200 yuan; surgical fees (with reference to the national standard, reimbursement for more than 1,000 yuan is based on 1,000 yuan). elderly people aged 60 years old or above are hospitalized in the health centers, and the compensation for treatment and nursing care fees is 10 yuan per day, with a limit of 200 yuan. Reimbursement rates: town health centers reimburse 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%. Major Diseases All hospitalized patients participating in the cooperative medical care are compensated in segments for the one-time or annual cumulative reportable medical expenses exceeding RMB 5,000, i.e. RMB 5,001-10,000 is compensated at 65%, and RMB 10,001-18,000 is compensated at 70%. The annual limit of compensation for inpatient hospitalization and outpatient blood dialysis for uremia, outpatient radiotherapy and chemotherapy for tumors is 11,000 yuan at the township level cooperative medical treatment. Exemptions Self-medical treatment (medical treatment in unspecified hospitals or without a referral order), self-purchased medicines, medicines that cannot be reimbursed under the provisions of public medical care and medical expenses not in accordance with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional fees, blood transfusion fees (except for those who have a family blood bank, which is reimbursed in accordance with the relevant regulations), heating and cooling fees, ambulance fees and other expenses such as special care fees; automobile accidents, fights, suicide, alcoholism, medical expenses for work accidents and medical malpractice; orthopedics, plastic surgery, dentures, prostheses, organ transplantation, named surgery fees, consultation fees, etc.; reimbursement within the scope and part beyond the limit. [2]? Urban If an urban resident is hospitalized more than twice in a billing year, the starting standard fee will no longer be charged from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference shall be made up in accordance with the prescribed starting standard of the hospital to which they are transferred or re-admitted. For students and children who have incurred medical expenses of less than RMB 180,000 that are eligible for reimbursement in a billing year, the starting standard is RMB 650 and the reimbursement rate is 50%, with an upper limit of RMB 2,000 for tertiary hospitals, RMB 300 and the reimbursement rate is 60% for secondary hospitals, and there is no starting standard for tertiary hospitals, and the reimbursement rate is 65%. For medical expenses under 100,000 RMB incurred within one billing year for those aged 70 and above that are eligible for reimbursement, the starting standard for Level III hospitals is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for Level II hospitals is 300 RMB, with a reimbursement rate of 60%; and Level I hospitals do not have a starting standard, with a reimbursement rate of 65%.

For other urban residents who have incurred medical expenses of less than 100,000 yuan that are eligible for reimbursement in a billing year, the starting standard for third-level hospitals is 659 yuan, with a reimbursement rate of 50% capped at 2,000 yuan; the starting standard for hospitalization in second-level hospitals is 300 yuan, with a reimbursement rate of 55%; and first-level hospitals do not have a starting standard, with a reimbursement rate of 60%. [3]? Employees Generally speaking, the economic development of different regions varies, so the reimbursement rate also varies, the following on the situation of the percentage of medical insurance coverage for employees in Beijing.

After getting health insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1800 RMB after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.

And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50% of the $500 portion can be reimbursed, which is $250. [4]? In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a year in 2009, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is RMB 650. And the maximum amount of payment from the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.

The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, which means 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, which means 90% reimbursement; for the portion of the expenses exceeding 40,000 yuan and up to the maximum payment limit, 95% of the expenses can be reimbursed, and the employee only has to pay 5%. And while retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, anything below the starting threshold is paid by the individual.

The diagnostic and therapeutic items that are not paid for by the basic medical insurance for employees are mainly non-clinically necessary and uncertain diagnostic and therapeutic items as well as diagnostic and therapeutic items for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and other categories such as infertility treatments, and so on. In accordance with the "national basic medical insurance treatment program scope", as follows:

(a) service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment expediting fee, surcharge for named surgery, quality and premium fee, self-invited special nurse and other special medical services.

(2) Non-disease treatment program category. (1) a variety of cosmetic, bodybuilding and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height increase program. (3) a variety of health checkups; (4) a variety of preventive, health care treatment programs; (5) a variety of medical consultation, medical appraisal.

(C) diagnostic and treatment equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy and other large medical equipment for examination and treatment programs; (2) glasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical.

(D) treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.

(v) Others. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program. [5]? See for yourself which one it belongs to. I hope to adopt!