I. Surgical expenses can be reported to health insurance, social health insurance reimbursement is reimbursed after discharge or transfer.
Second, hospitalization and outpatient treatment of special diseases settlement procedures:
1, the designated medical institutions in the previous month before the 10th of each month, will be discharged from the patient's fee statement, hospitalization statement and related information to the health insurance agency, the health insurance agency audit, as a monthly preallocation and year-end final accounts based on;
2, the health insurance agency monthly The medical insurance agency will preallocate the coordinated expenses for hospitalization and outpatient treatment of special diseases for the previous month;
3. Participants who are recognized as suffering from special diseases should go to a designated medical institution designated by the labor security department to seek medical treatment and purchase medicines, and the incurred medical expenses will be recorded directly in the account and settled instantly.
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Expanded Information:
Medicare Reimbursement Ratio:
I. Rural
1. Outpatient: 60% reimbursement for village health clinics and village center health clinics, with a limit of 10 yuan per visit for prescription drugs, and a limit of 50 yuan per visit for temporary rehydration of prescription drugs by the doctor of the health center; 40% reimbursement for the township health center visit, with a limit of 50 yuan for each visit for each check-up fee and surgical procedure, and a limit of 100 yuan for prescription drugs.
2, hospitalization: reimbursement: medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement of 1,000 yuan). 60 years of age or older hospitalized in a health center, the treatment costs and nursing care compensation of 10 yuan a day, limit of 200 yuan. Reimbursement rates: 60% for town health centers; 40% for secondary hospitals; and 30% for tertiary hospitals.
3. Major illnesses: All hospitalized patients who participate in cooperative medical care are compensated for the one-time or yearly cumulative reportable medical expenses over 5,000 yuan, i.e., 5,001-10,000 yuan is compensated at 65%, and 10,001-18,000 yuan 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.
4. Exemptions: self-medical treatment (without designated hospitals for medical treatment or without referral orders), self-purchased medicines, medicines that cannot be reimbursed under the public medical care regulations and medical expenses not in line with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, accompanying fees, nutritional fees, blood transfusion fees (except for those who have blood stored in their families, which are reimbursed in accordance with the relevant regulations), heating and cooling fees, ambulance fees, and special nursing care fees Other expenses; medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice; orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.; reimbursement within the scope of reimbursement, but outside the limit.
Two, urban
1, urban residents who are hospitalized for more than two times in a settlement year will not be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or are hospitalized for more than two times, they shall make up the difference in accordance with the starting standard of the hospital to which they are transferred or to which they are re-admitted.
2. Students and children: For medical expenses under 180,000 RMB incurred within a settlement 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%.
3. 70 years old and above: for medical expenses under 100,000 RMB incurred within one billing year that meet 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 secondary hospitals is 300 RMB, with a reimbursement rate of 60%; and the reimbursement rate for first-class hospitals does not have any starting standards, with a reimbursement rate of 65%.
4. Other urban residents: for medical expenses under 100,000 RMB incurred in a billing year that meet the scope of reimbursement, the starting standard for third-level hospitals is 659 RMB, and the reimbursement rate is 50% with an upper limit of 2,000 RMB; the starting standard for second-level hospitals' inpatient hospitalization is 300 RMB, and the reimbursement rate is 55%; and the reimbursement rate for first-level hospitals does not have a starting standard, and the reimbursement rate is 60%.
Source:/baike.baidu.com/item/%E5%8C%BB%E4%BF%9D%E6%8A%A5%E9%94%80%E6%AF%94%E4%BE%8B/4277454 "target="_blank "title="Support only when a link is selected Effective">Baidu Encyclopedia: Health Insurance Reimbursement Ratio