1. The starting line for township hospitals is 100-150 yuan, and the hospitalization reimbursement ratio is 85%-95%;
2. The starting line for county hospitals is 300-400 yuan, and the hospitalization reimbursement ratio is 70%-85%;
3. Municipal hospitals have a starting line of RMB 800-2000, with a hospitalization compensation ratio of 60%-65%;
4. Provincial hospitals have a starting line of RMB 2000-2500, with a hospitalization compensation ratio of 50%-55%;
5. The starting line for level 3 and above of hospitals outside the province is RMB 4000-5000, and the hospitalization compensation ratio is 40%-45%.
Meanwhile, the cap line for hospitalization compensation for participating farmers to see a doctor was raised from 100,000 yuan per person per year in 2014 to 120,000 yuan this year. The cap line is calculated cumulatively throughout the year. Compensation for medical treatment of major diseases is calculated separately.
I, outpatient reimbursement rate:
1, community health service centers, town health centers reimbursement rate of 85%;
2, the first level of hospitals (county hospitals, county maternity and child health hospitals) reimbursement rate of 75%;
3, the second level of hospitals (the county people's hospitals, the county hospital of traditional Chinese medicine) reimbursement rate of 70%;
4, third level of hospitals ( Bin Medical Hospital, Binzhou People's Hospital, the city center hospital, the city hospital, etc.) reimbursement rate of 55%.
The reimbursement rate of medical insurance for major diseases:
1, the part of the individual's burden of the standard medical expenses of less than 12,000 yuan will not be reimbursed.
2. 50% reimbursement will be given for the part of the regular medical expenses borne by individuals above 12,000 yuan (including 12,000 yuan) and below 100,000 yuan;
3. 60% reimbursement will be given for the part of the medical expenses above 100,000 yuan (including 100,000 yuan) and below 200,000 yuan;
4. 65% reimbursement will be given for the part of the medical expenses above 200,000 yuan (including 200,000 yuan) and the maximum amount of reimbursement will be given to each person. 300,000 yuan reimbursement is given.
Medicare reimbursement is 85%, and if it exceeds the basic limit, then the social insurance department will reimburse 85% according to: 0-40,000 yuan or less, 40,000 yuan - 80,000 yuan or less, 90%, and 80,000 yuan or more, 95%. Medicare refers to social health insurance. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide protection to workers covered by the insurance for their basic medical needs in case of illness. The basic medical insurance fund consists of a general fund and individual accounts. The basic medical insurance premiums paid by individual workers are all credited to their individual accounts; the basic medical insurance premiums paid by employers are divided into two parts, one of which is credited to the individual accounts and the other is used to build up the general fund. The basic medical insurance scheme is characterized by "low level and wide coverage", with contributions based on a low level of costs that the vast majority of units and individuals can afford, and with wide coverage of all units and workers in towns and cities, so that workers in units of different natures can all enjoy the right to basic medical insurance. Participants can enjoy the right to basic medical insurance for the rest of their lives after completing their contribution period. Secondly, the basic medical insurance is characterized by "both sides of the burden, the united accounts"; "to determine the expenditure with income, revenue and expenditure balance" as the principle.
Legal basis:
The People's Republic of China Social Insurance Law
Article 26 The basic medical insurance for employees, the new type of rural cooperative medical care and the basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.
Article 27 Individuals who have participated in basic medical insurance for employees and whose accumulated contributions have reached the number of years prescribed by the State by the time they reach the legal retirement age shall not pay any more basic medical insurance premiums after their retirement and shall enjoy basic medical insurance benefits in accordance with the State's stipulations; and those who have not yet reached the number of years prescribed by the State may pay contributions up to the number of years prescribed by the State.
Article 28 Medical expenses that conform to the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.