Medical bonus reimbursement ratio:
1. The reimbursement ratio of medical insurance is 85%;
2. The charging standard of second-class hospitals starts The levy point is 400. The reimbursement rate of medical insurance is 70%;
3. The starting point for charging standards for first-class hospitals is 600. The reimbursement rate of medical insurance is 60%;
4. If a first-class hospital is transferred to the province for medical treatment, the starting point of the charging standard is 600. The reimbursement rate of medical insurance is 60%;
5. When a first-class hospital transfers to a hospital outside the province for medical treatment, the starting point of the charging standard is 600. The reimbursement rate of medical insurance is 55%;
6. If you are hospitalized multiple times in one insurance year, the deductible payment standards for the first and second hospitalizations will be borne by the individual. The deductible standard for hospitalization for the third time and above is paid from the overall fund. The maximum payment limit for an insurance annual pooled fund is RMB 50,000.
Medical insurance reimbursement scope and standards:
1. Drugs are divided into Class A, Class B and Class C drugs. Among them, Class A drugs are necessary for clinical treatment and are widely used. All drug fees for similar drugs are reimbursed according to the proportion stipulated by medical insurance. Class B drugs require a certain percentage to be paid out of pocket first, and then reimbursed by medical insurance. The specific reimbursement ratio is stipulated by the medical insurance bureaus in different places;
2. The diagnosis and treatment items refer to the items used by the hospital during treatment. Medical instruments, equipment and medical materials are mainly reimbursed in two ways. Fully coordinated items are all included in medical insurance reimbursement and paid according to the prescribed proportion. For some coordinated projects, you need to pay part of it out of pocket first, and then reimburse according to the prescribed proportion;
3. Medical service facility standards refer to inpatient bed fees, outpatient and emergency stay bed fees, etc. The reimbursement scope and standards are different. If it is the scope of medical insurance reimbursement in social insurance, it is reimbursed for items in the medical insurance catalog, including medicines, diagnosis and treatment items, and medical service facilities.
Legal basis: Article 2 of the "Social Insurance Law of the People's Republic of China"
The state establishes basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, etc. The social insurance system guarantees citizens’ rights to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.
Article 28
Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be deducted from the basic medical insurance fund in accordance with national regulations. Pay.