Hospitalization reimbursement rate is different, according to 60% of the rate to reimbursement of about 9,000 yuan, health insurance reimbursement rate: 1. Prerequisites: the starting standard to the basic medical insurance fund maximum payment limit part; 2. active employees to pay the proportion of respectively: community health centers 93%, 88% of the first level of hospitals, 86% of the second level of hospitals, third level of hospitals, 84%; 3. retired people to pay The proportion of payment for retirees is 96.5% for community health centers, 94% for first-level hospitals, 93% for second-level hospitals and 92% for third-level hospitals; 4. The rest of the costs are borne by individuals. Generally class A drugs can enjoy full reimbursement, class C will need to pay all the out-of-pocket expenses, while class B reported 80%, the proportion of 20% out-of-pocket.
Medicare reimbursement process is as follows:
Participants with ID cards and doctors admission arrangements, first pay the hospital deposit hospitalization. When discharged from the hospital, go to the hospital inpatient charging office to settle the discharging expenses. Then the hospitalization bill, the fee bill, the insured's medical card and ID card, go to the affiliated medical institution for reimbursement.
The amount that can be reimbursed by the medical insurance is as follows: Reimbursement = (total medical expenses - out-of-pocket expenses - out-of-pocket payments - starting line) * reimbursement rate, under normal circumstances, the actual reimbursement rate is 20% to 60%. Out-of-pocket expenses are the amount outside the scope of reimbursement; out-of-pocket expenses are the expenses that are within the scope of reimbursement but still need to be borne by oneself; 80% of reimbursement for Class B drugs, bed fee has a limit, and some examination and consultation fees are not reimbursable according to the regulations; the reimbursement of the medical insurance card is 4 times of the average salary of the local social workers (the cumulative value in 1 year). The money in the medical insurance card can be used to buy medicines in designated pharmacies and pay for outpatient and emergency treatment, but it is not part of the reimbursement scope, because the money in the card is the money in the individual account of the medical insurance; the individual out-of-pocket expenses incurred by the participant in the municipal medical insurance designated medical institutions after suffering from a major disease and in line with the provisions of the city's health care insurance are included in the scope of the payment of the resident's major disease insurance, and are reimbursed by the funds of the major disease insurance for 50 percent of the amount of reimbursement, i.e., reimbursement amount = out-of-pocket expense x 50%.
Medicare also has exclusions, and the following ten items are not covered by Medicare.
1. Special medical expenses for organ and tissue transplants due to medical conditions, the cost of purchasing organs and tissues, as well as the use of anti-rejection drugs and immunomodulatory drugs beyond the scope of Zhenjiang Employee Health Insurance Drug Reimbursement; 2. work-related injuries and occupational diseases; 3. maternity for female workers; 4. hooliganism and assaults; 5. alcoholism and injuries; 6. traffic accidents; 7. intentional injuries of others; 8. medical accidents; 9. cosmetic and cosmetic surgery; and 10. Medical accidents; 9. Beauty and health checkups; 10. Other expenses not covered by the social medical insurance fund.
Legal basis: "the Chinese people's *** and the whole of the State Social Insurance Law" Article 23 employees shall participate in the basic medical insurance, by the employer and the employee in accordance with the provisions of the State *** with the payment of basic medical insurance premiums. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance of employees in the employing organization, and other flexibly employed persons may participate in the basic medical insurance of employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.