Civil servant medical insurance reimbursement ratio:
(1) outpatient cost reimbursement ratio of the incumbent (within the year on-campus and off-campus medical expenses are combined): less than or equal to 3,000 yuan: 80% reimbursement of the public medical expenses, the individual burden 20%; greater than 3,000 yuan: 90% reimbursement of the public medical expenses, the individual burden 10%; incumbent hospitalization cost reimbursement ratio (within the year): less than or equal to 10,000 yuan: 90% reimbursement of the public medical expenses, the individual burden 10 %;
(2) outpatient cost reimbursement ratio for retirees (annual on-campus and off-campus medical expenses combined): less than or equal to 3,000 yuan: public medical reimbursement 90%, personal burden 10%; greater than 3,000 yuan: 95% reimbursement at public expense medical care, personal burden 5%; retiree hospitalization expense reimbursement ratio (within the year): less than or equal to 10,000 yuan: 95% reimbursement at public expense medical care, personal burden 5%; greater than 10,000 yuan: 97% reimbursement at public expense medical care, personal burden 3%;
(3) outpatient expenses of students who are entitled to public medical care are reimbursed 90%, with a personal burden of 10%; hospitalization expenses are 95% reimbursement, personal burden 5%.
(4) The reimbursement rates for retirees and medical caregivers are still in accordance with the original regulations.
Expanded information:
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 more than twice, the difference will be made up in accordance with the 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 Level III hospitals is 650 RMB, with a reimbursement rate of 50% and a ceiling 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%.
Over 70 years old and above
In a settlement year, for medical expenses of less than 100,000 RMB incurred within 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; the starting standard for second-level hospitals is 300 RMB, with a reimbursement rate of 60%; and there is no starting standard for first-level hospitals, with a reimbursement rate of 65%
Other urban residents
Other urban residents
In a billing year, for medical expenses of less than 100,000 yuan that are eligible for reimbursement, the starting standard for third-level hospitals is 659 yuan, and the reimbursement rate is 50% capped at 2,000 yuan; the starting standard for second-level hospitals' hospitalization is 300 yuan, and the reimbursement rate is 55%; and first-level hospitals don't have any starting standard, and the reimbursement rate is 60%.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person lives, such as living in a third-level hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or reimbursement of 85%; 30,000 yuan to 40,000 yuan, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the highest limit of payment of the portion of the cost, then 95% of the cost of the reimbursement, 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 covered by the basic medical insurance for employees are mainly those that are not clinically necessary, those whose effects are uncertain, and those 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 others such as infertility treatments, etc. The basic medical insurance for employees is not covered by the basic medical insurance.
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