1. What is the reimbursement ratio of urban and rural medical insurance?
According to the following judgment:
First, students and children.
In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
The second is the elderly over 70 years old.
In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
Third, other urban and rural residents.
In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.
If urban and rural residents are hospitalized for more than two times in a settlement year, starting from the second hospitalization, the Qifubiaozhun fee will no longer be charged. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.
Second, how to reimburse medical insurance in different places?
1, reimbursement in different places (refer to the province).
First of all, call the Social Security Bureau for the specific reimbursement policy of the new rural cooperative medical system, issue a referral form in the local hospital, and then go to the local Social Security Bureau for filing. Then, after going through the hospitalization formalities in the superior hospital, you can get the reimbursement subsidy directly after you leave the hospital.
2, remote reimbursement (referral outside the province).
Assuming that the deductible line for medical treatment outside the province is 2000 yuan, the compensation ratio is 35%~65%, but considering the inconsistency of reimbursement policies in different places, the actual compensation ratio may be lower after all calculations. I would like to remind you that the referral certificate is not so easy to open, and the condition is usually that there is no local equipment to treat this disease, so it will be easy to refer from the county to a higher-level hospital.
3, remote reimbursement (non referral).
Considering that there are many restrictions on referral, many people go to other cities for medical treatment without referral. Then, according to the example of Laos, if referral is not considered, the actual reimbursement rate may not even be 35%, and the reimbursement rate will only be between 0% and 35%.
If the employee medical insurance is used to calculate, suppose that in Shenzhen, the reimbursement rate is 90%, and the hospitalization expenses incurred without referral should be paid in cash first, and then the reimbursement rate will be reduced by 30% according to relevant documents. For those who have not been referred to the mainland for medical treatment, the hospitalization medical expenses incurred in designated hospitals outside Shenzhen can be directly reimbursed by medical insurance cards, and the reimbursement ratio is reduced by 10 percentage point.
Therefore, the reimbursement rate for hospitalization in different places is between 60% and 80%, but the reimbursement must meet the scope of reimbursement!
The minimum payment standard and reimbursement ratio of basic medical insurance for urban and rural residents are determined according to the categories of insured persons, such as students, children, the elderly over 70 years old and other urban and rural residents. Including different levels of hospitals, the reimbursement ratio is also different. According to the actual situation.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: Article 23 of the full text of the Social Insurance Law.
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.