(a) Rural
1, outpatient
Village health clinic and village center health clinic visit reimbursement of 60%, each visit to the prescription drug fee limit of 10 yuan, the health center doctor temporary rehydration of the prescription drug fee limit of 50 yuan;
Township health center visit reimbursement of 40%, each visit to each examination and surgical fee limit of 50 yuan, prescription drug fee limit of 100 yuan;
secondary hospitals visit reimbursement 30%, each visit to each examination and surgical fee limit of 50 yuan. Prescription drug cost limit of 100 yuan;
Second-level hospital visit reimbursement of 30%, each visit to the examination fees and surgical fees limit of 50 yuan, prescription drug cost limit of 200 yuan;
Tertiary hospital visit reimbursement of 20%, each visit to the examination fees and surgical fees limit of 50 yuan, prescription drug cost limit of 200 yuan;
Chinese medicine invoices attached to the prescription limit of 1 yuan per sticker Township-level cooperative medical outpatient reimbursement is limited to 5,000 yuan per year.
2. Hospitalization
Reimbursement scope:
Medicine fees: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic **** vibration and other various examination fees limit of 200 yuan;
Surgery fees (with reference to the national standard, more than 1,000 yuan reimbursement of 1,000 yuan).
Elderly people aged 60 years or above in the health center hospitalized, treatment and nursing fees are reimbursed at 10 yuan per day, with a limit of 200 yuan.
Reimbursement rates: township health centers reimburse 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.
3. Major Diseases
Any hospitalized patient who participates in the cooperative medical care will be reimbursed for the one-time or yearly cumulative reportable medical expenses of more than 5,000 yuan, i.e., 65% of 5,001-10,000 yuan, and 70% of 10,001-18,000 yuan.
The annual limit of compensation for township-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy is 11,000 yuan.
(2) Township residents
Township residents who are hospitalized for more than two times in a billing year will not be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference shall be made up in accordance with the prescribed starting standard for transferring to or re-admitting to the hospital.
1. Students and children
In a billing year, for medical expenses of less than 180,000 RMB incurred 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%.
2, aged 70 and above
In a billing year, if the medical expenses of less than 100,000 yuan are eligible for reimbursement, the starting standard of the third-level hospitals is 650 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan; the starting standard of the second-level hospitals is 300 yuan, and the reimbursement rate is 60%; and the first-level hospitals don't have any starting standard, and the reimbursement rate is 65%.
3, other urban residents
In a settlement year, incurred in line with the scope of reimbursement of medical expenses of less than 100,000 yuan, the starting standard for tertiary hospitals 659 yuan, the reimbursement rate of 50% capped at 2,000 yuan; hospitalization in secondary hospitals starting standard of 300 yuan, the reimbursement rate of 55%; first-class hospitals do not have a starting standard, the reimbursement rate of 60%.
(C) employees
Generally speaking, the economic development of different regions is different, so the reimbursement rate also varies, the following on the situation of the proportion of workers' health insurance coverage in Beijing.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1,800 yuan after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50 percent of the $700 portion is reimbursed, which is $350.
In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a 2009 year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is 650 yuan. And the maximum amount of payment from the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement; 30,000 yuan to 40,000 yuan, the employee pays 10%, 90% reimbursement; over 40,000 yuan to the maximum payment limit part of the expenses, then 95% can be reimbursed, the employee only needs to pay 5%. And retirees personally pay 60 percent of the rate for active (that is, the aforementioned) employees, but anything below the threshold is paid by the individual.
The diagnostic and therapeutic items that are not paid for by the basic medical insurance for employees are mainly non-clinically necessary and uncertain diagnostic and therapeutic items as well as diagnostic and therapeutic items for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and other categories such as infertility treatments, etc. In accordance with the "National Basic Medical Insurance Diagnostic and Therapeutic Items", the basic medical insurance for employees is not paid by the employees. In accordance with the "national basic medical insurance treatment program scope", as follows:
1, service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment of expedited fee, named surgery surcharge, quality premium fee, self-employed special nurses and other special medical services.
2, non-disease treatment program category. (1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height projects; (3) a variety of health checkups; (4) a variety of preventive, health care diagnostic and treatment programs; (5) a variety of medical consultation, medical appraisal.
3, diagnostic equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy and other large medical equipment for examination and treatment programs; (2) glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical.
4, treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valve, cornea skin, blood vessels, bone, bone marrow transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic projects.
5. Others. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
Legal basis:
The People's Republic of China **** and the State Social Security Law
Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall pay the basic medical insurance premiums in accordance with the state regulations **** the same.
Individual industrial and commercial households without employees, part-time employees who do not participate in the basic medical insurance for employees at their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, with individuals paying the basic medical insurance premiums in accordance with the state regulations.
Article 24 The State establishes and improves the new rural cooperative medical care system.
Methods for administering the new type of rural cooperative medical care shall be prescribed by the State Council.
Article 25 The State establishes and perfects the basic medical insurance system for urban residents.
Basic medical insurance for urban residents is a combination of individual contributions and government subsidies.
The government shall subsidize the part of individual contributions required by those who enjoy the minimum subsistence guarantee, persons with disabilities who have lost the ability to work, and the elderly and minors over sixty years of age from low-income families.