1. Urban non-employed residents
Community health service institutions, the overall fund to pay 70%, individuals bear 30%;
A hospital, the overall fund to pay 60%, individuals bear 40%;
Secondary hospitals, the overall fund pays 50%, and individuals bear 50%;
In tertiary hospitals, 40% is paid by the overall fund and 60% is borne by individuals.
2 children's overall fund payment ratio increased by 5% according to the corresponding standards of urban non-employed residents.
1. What is the reimbursement rate of medical insurance for urban residents?
1, underage and school students
In a settlement year, medical expenses that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 600 yuan, and the reimbursement ratio is 65%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 75%; Level I hospital threshold 150 yuan, and the reimbursement rate is 85%.
2. Non-employed residents
In a settlement year, medical expenses that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 2000 yuan, and the reimbursement ratio is 65%; The minimum threshold for secondary hospitals is 1000 yuan, and the reimbursement rate is 75%. The qifubiaozhun for first-class hospitals is 500 yuan, and the reimbursement rate is 85%.
3. Elderly residents
Within a settlement year, medical expenses that meet the scope of reimbursement occur, and the deductible line of tertiary hospitals is 1400 yuan, and the reimbursement ratio is 65%; The Qifubiaozhun for hospitalization in secondary hospitals is 700 yuan, and the reimbursement rate is 75%; The threshold for first-class hospitals is 350, and the reimbursement rate is 85%.
2. What is the proportion of hospitalization reimbursement for medical insurance for urban and rural residents?
1, reimbursement scope
A. Medical expenses: auxiliary examination: 200 yuan can reimburse the examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance. Surgical expenses (according to national standards, the part above 1000 yuan shall be compensated by 1000 yuan).
B, the elderly over 60 years old are hospitalized in the town health center, and the treatment and nursing expenses incurred can be compensated 10 yuan every day, with the maximum not exceeding 200 yuan.
2. Proportion of reimbursement
The compensation ratio of town hospitals is 60%; The proportion of compensation for secondary hospitals is 40%; The proportion that tertiary hospitals can compensate is 30%.
3. Compensation for serious illness
Town risk fund compensation: as long as the inpatients who bought the cooperative medical system can report medical expenses higher than 5,000 yuan at one time or annually, they will be reimbursed by stages.
That is, 500 1- 10000 yuan is 65%, and 1 001-18000 yuan can get 70% compensation, and the maximum compensation in town-level cooperative medical hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy does not exceed/kloc-.
Third, how to reimburse medical insurance in different places?
1, reimbursement in different places (refer to the province).
First of all, call the Social Security Bureau for the specific reimbursement policy of the new rural cooperative medical system, issue a referral form in the local hospital, and then go to the local Social Security Bureau for filing. Then, after going through the hospitalization formalities in the superior hospital, you can get the reimbursement subsidy directly after you leave the hospital.
2, remote reimbursement (referral outside the province).
Assuming that the deductible line for medical treatment outside the province is 2000 yuan, the compensation ratio is 35%~65%, but considering the inconsistency of reimbursement policies in different places, the actual compensation ratio may be lower after all calculations. I would like to remind you that the referral certificate is not so easy to open, and the condition is usually that there is no local equipment to treat this disease, so it will be easy to refer from the county to a higher-level hospital. However, it is very difficult to refer from the provincial capital city hospital to Beijing.
3, remote reimbursement (non referral).
Considering that there are many restrictions on referral, many people go to other cities for medical treatment without referral. Then, according to the example of Laos, if referral is not considered, the actual reimbursement rate may not even be 35%, and the reimbursement rate will only be between 0% and 35%.
legal ground
Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers
Article 31
The basic medical insurance fund to pay part of the cost of diagnosis and treatment projects and class B drugs list, the proportion of individual pays, determined by the provincial people's government.
Thirty-second medical expenses of class A infectious diseases such as cholera and plague shall be paid by the overall fund. The medical expenses of explosive and epidemic infectious diseases confirmed by the administrative department of health shall be solved by the people's government.
Article 33 State civil servants and other qualified personnel shall, on the basis of participating in basic medical insurance, implement medical subsidies.
In order to solve the medical expenses above the maximum payment limit for personnel other than those specified in the preceding paragraph, the provincial people's government may organize the implementation of supplementary medical insurance.