Legal subjectivity:
What is the reimbursement ratio for medical insurance? See the following content:
Based on the different insured groups, my country’s medical insurance can be divided into urban employee medical insurance, urban resident medical insurance and rural new rural cooperative medical insurance. The outpatient reimbursement ratios of these three types of medical insurance are different. The outpatient reimbursement ratios for common diseases and special diseases are also inconsistent, which will be analyzed separately below.
1. Urban employee medical insurance
a. In-service employees: The outpatient exemption limit is 2,000 yuan, that is, only the part of the medical expenses incurred in the outpatient service exceeding 2,000 yuan will be reimbursed. , the reimbursement ratio is 50%;
b. Retired employees: The outpatient exemption limit is 1,300 yuan, that is, only the part of the medical expenses incurred in the outpatient service exceeding 1,300 yuan will be reimbursed, and those under 70 years old will be reimbursed. , the reimbursement rate is 70%, and those over 70 years old, the reimbursement rate is 80%.
c. Maximum limit: No matter what type of person, the maximum limit for large-amount medical expenses paid for outpatient and emergency services is 20,000 yuan.
d. Special diseases: Within one medical insurance year, the exemption limit for outpatient services for special diseases is 400 yuan, and the reimbursement ratio of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization.
2. Urban Resident Medical Insurance
a. General outpatient clinic: Within a medical insurance year, there is no deductible for general outpatient clinics, and the medical expenses covered by the outpatient pooling fund are covered at 60% The annual maximum individual payment limit of the overall fund is 400 yuan.
b. Special diseases: Within one medical insurance year, the exemption limit for outpatient services for special diseases is 400 yuan, and the reimbursement ratio of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization.
3. New Rural Cooperative Medical Insurance
a. Village clinics and village center clinics are reimbursed for 60% of their visits, with a limit of 10 yuan for prescription drugs per visit, and temporary rehydration of prescription drugs by doctors at the health center. The fee limit is 50 yuan.
b. The town health center reimburses 40% of the fees for each visit, with a limit of 50 yuan for examination fees and surgical fees, and a limit of 100 yuan for prescription drugs.
c. 30% reimbursement for visits to secondary hospitals, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 200 for prescription drugs.
d. 20% reimbursement for visits to tertiary hospitals, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.
e. There is a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice.
f. The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.
g. Special diseases: Within one medical insurance year, the outpatient exemption limit for special diseases is 400 yuan, and the reimbursement ratio of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization.
After reading the above content, you must have a general understanding of the medical insurance reimbursement ratio. Legal objectivity:
"Social Insurance Law of the People's Republic of China"
Article 26
Employee basic medical insurance, new rural cooperative medical insurance and The treatment standards of basic medical insurance for urban residents shall be implemented in accordance with national regulations.
"Social Insurance Law of the People's Republic of China"
"Social Insurance Law of the People's Republic of China"
Article 28
p>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 paid from the basic medical insurance fund in accordance with national regulations.
"Social Insurance Law of the People's Republic of China"
"Social Insurance Law of the People's Republic of China"
Article 29
p>The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.
The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.