How to reimburse urban residents' basic medical insurance
What is the scope of urban medical insurance? How to reimburse the basic medical insurance for urban residents? The following I will provide you with a detailed description!
What is the scope of reimbursement for urban health insurance?
A current China's urban residents of the basic medical insurance system provides: urban residents of the basic medical insurance reimbursement mainly, the insured person in the designated medical institutions, designated retail pharmacy costs of the following items into the urban residents of the basic medical insurance fund reimbursement scope: hospitalization medical costs; emergency detention and transferred to hospitalization within seven days before the medical costs; the urban residents of the basic medical insurance fund reimbursement. Medical expenses for hospitalization; medical expenses incurred within 7 days before being transferred to inpatient treatment for emergency treatment; medical expenses in accordance with the provisions of outpatient special diseases for urban residents. However, the situation is different by provinces and regions, and at present China's human resources and social security bureau did not carry out unified regulations on the scope of reimbursement of medical insurance by the provinces and cities in accordance with national policies, combined with the actual situation in the local community, for example, Guangzhou, in addition to the reimbursement of the national provisions of the scope of reimbursement is also added in the second and third level of designated medical institutions in the emergency observation room for observation of the hospital for the treatment; in the first and second level of designated medical institutions or designated community health service institutions to provide 'medical expenses'. The community health service institutions to open the 'family hospital bed for treatment; malignant tumors in the designated designated medical institutions for outpatient chemotherapy, radiation therapy and its period of auxiliary treatment costs, such as medical insurance reimbursement scope.
The scope of urban residents' basic medical insurance is not reimbursed:
1. Self-purchase of medicines;
2. Should be paid out of the Workers' Compensation Insurance Fund;
3. Should be borne by a third party;
4. Should be borne by the public **** health;
5, To go abroad for medical treatment;
6. Other cases stipulated by laws and regulations in which the fund is not reimbursed.
In addition, work injuries, occupational diseases, hooliganism, alcoholism, traffic accidents, intentional injury to others, medical accidents, cosmetic surgery, health checkups are also not covered by the residents of the basic medical insurance fund.
How to reimburse urban residents for basic medical insurance
1. Outpatient reimbursement:
(1) General outpatient: 30 yuan per person per year reimbursement, non-accumulative use of the next year (outpatient visits to the designated community health service organizations to buy drugs).
(2) outpatient special diseases: insured residents suffering from malignant tumors (including leukemia) chemotherapy, renal failure, uremia outpatient dialysis, cirrhosis treatment of outpatient special diseases, can be reimbursed in accordance with the policy to enjoy outpatient special diseases. Participating residents adults suffering from outpatient special diseases, a payment year, in addition to hospitalization, outpatient cumulative medical expenses incurred up to the payment limit of 3,000 yuan; children and teenagers and students suffering from outpatient special diseases, a co-ordination year, in addition to hospitalization, outpatient cumulative medical expenses incurred up to a maximum payment of 10,000 yuan.
2. Hospitalization basic medical insurance reimbursement: hospitalization in line with the autonomous region? Three catalogs? and the "Notice on Issues Related to Children's Medicines for Urban Residents' Basic Medical Insurance" (hereinafter referred to as the policy scope), the maximum declaration amount of basic medical care is 100,000 yuan, and the expenses above the starting line up to 100,000 yuan are reimbursed in accordance with the policy ratio.
For example: in 2008, if a new resident is hospitalized in a first-level medical institution (such as the Red Cross Health Service Center in Hami City), the starting standard is 200 yuan, and the health insurance reimbursement is 60%; hospitalized in a second-level medical institution (such as the 13th Division Red Star Hospital, the Second People's Hospital of the region, etc.), the starting standard is 400 yuan, and the health insurance reimbursement is 55%; hospitalized in a third-level medical institution (such as the Central Hospital of the region, the People's Hospital of the Autonomous Region, etc.), the starting standard is 400 yuan, and the health insurance reimbursement is 55%. Center Hospital, Autonomous Region People's Hospital, etc.) starting standard is 600 yuan, 50% reimbursement of medical insurance.
Participants in the continuous annual contributions, each year of premium reimbursement rate increased by 2%, an increase of up to 20%. For example: residents from the 2008 year to pay resident health insurance premiums continuously paid to the 2015 year, continuous payment of eight years, the residents in the hospital hospitalization reimbursement rate increased to 16%, if the residents in 2015 hospitalization, the first level of medical institutions, medical insurance reimbursement of 76%; second level of medical institutions 71%; third level of medical institutions medical insurance reimbursement of 66%.
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