1, the reimbursement rate of basic medical insurance for urban workers is relatively high, generally above 70%;
2. The reimbursement rate of basic medical insurance for urban residents is relatively low, generally around 50%;
3. The reimbursement rate of the new rural cooperative medical system varies from region to region, generally between 50% and 80%.
The proportion of medical insurance reimbursement is as follows:
1, 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 for first-class hospitals, and the reimbursement rate is 65%;
They are old people in their seventies. 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 for first-class hospitals, and the reimbursement rate is 65%;
They are residents of other towns. 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%.
The medical insurance reimbursement process is as follows:
1. Hospitalization medical expenses shall be paid by individuals in advance. After discharge, medical insurance card, ID card, outpatient medical record, discharge summary, general list of expenses (detailed list of expenses), disease diagnosis certificate, valid bill (original invoice), doctor's advice, copy of the first page of medical record, certificate issued by the school, certificate of transfer to hospital and relevant certificate issued by the college shall be provided. For medical treatment in different hospitals, materials from different hospitals should be provided; In the same hospital, according to the different hospitalization time (before the expenses are written off, such as being treated in the same hospital after discharge), materials of hospitalization in different periods should also be provided;
2, after the opening of the credit card settlement function, the student himself or his guardian or client shall, within three days of hospitalization, go to the medical window of the service hall of the municipal medical insurance center with the student ID card, the provincial social security card, the medical record of the hospital, the certificate of disease diagnosis and the certificate issued by the college;
3. Treatment of emergency expenses of non-designated medical institutions: within 3-5 working days of emergency, first contact or entrust others to register with the municipal medical insurance management center through the student medical insurance management center of our hospital, and the medical expenses will be paid in advance by myself. At the time of reimbursement, apply for reimbursement to the municipal medical insurance center with the above reimbursement materials (non-medical insurance designated hospitals or clinics cannot be reimbursed).
To sum up, even different hospitals in the same area may have different reimbursement rates. Therefore, when choosing a hospital for medical treatment, besides considering the reimbursement ratio, we also need to comprehensively consider the hospital's medical technology, service quality and expert resources in order to choose the most suitable medical institution.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.