The impact of off-site medical reimbursement ratio is not small, the city's hospitalization reimbursement ratio outside the coordinated area is only 45.59%, and self-transferring off-site medical reimbursement ratio is 30%.
Medicare reimbursement scope:
1, medical insurance coverage of hospitalization medical expenses insurance responsibility, by the basic medical insurance, major medical insurance, medical assistance and other reimbursement is still borne by the individual part of the cost of medical insurance directory, in the agreed scope of the insurance responsibility for payment. 1 million coverage, 15,000 yuan deductible, reimbursement rate of 80%, continuous participation in reimbursement rate increased to 85%;
2, hospitalization medical expenses insurance liability outside the scope of medical insurance, through the basic medical insurance, major disease insurance, medical assistance and other reimbursement is still borne by individuals outside the directory of the medical insurance part of the cost, in the agreed scope of the insurance liability to assume the responsibility to pay.1 million coverage, 18,000 yuan deductible, reimbursement rate of 60%, continuous participation in the reimbursement rate up to 65%;
3, outpatient specific high-risk medical expenses, the reimbursement rate of 80%, continuous participation in the reimbursement rate of 65%;
3, outpatient specified high drug cost insurance liability, in designated hospitals, designated pharmacies expenditure of drug costs, the part of the individual's burden, in the agreed scope of the insurance liability to bear the responsibility to pay. 700,000 coverage, 26 kinds of drugs, with the specified rare disease outpatient drug/inpatient medical insurance cost insurance liability *** with 20,000 yuan deductible, the reimbursement ratio of 80%;
4, specified rare disease Outpatient drug/inpatient medical insurance expense insurance liability, the part of drug expenses in designated hospitals and designated pharmacies that are borne by the individual will be liable for payment within the scope of the agreed insurance liability. 300,000 insured amount, 12 kinds of drugs, and outpatient specified high drug expense insurance liability*** with 20,000 yuan deductible, reimbursement ratio of 70%.
In summary, the close convergence of basic medical insurance (including urban workers' basic medical insurance, urban and rural residents' basic medical insurance), universal price and other characteristics. It focuses on the protection of high medical expenses caused by major diseases and accidents, and provides more adequate protection for major diseases. Compared with general commercial insurance, there is no restriction on the age and occupation of the insured, and the health requirements are more lenient. Meanwhile, it expands the cost of treatment for 20 high-cost specific drugs outside the medical insurance catalog and 10 designated rare disease drugs.
Legal basis:
Article 2 of the Insurance Law of the People's Republic of China*** and the State of China
Insurance, as referred to in this law, refers to the insurance policyholder, according to the contract, pays the premiums to the insurer, and the insurer bears the responsibility of compensating the insurance premiums for the property losses caused by the contractually agreed upon accidents that may occur due to the occurrence of the accident or when the insured person's death, disability, disease, or reaching the age, duration and other conditions agreed in the contract. The commercial insurance behavior of the insured's death, disability, illness, or when the insured person reaches the age and term agreed in the contract to assume the responsibility of paying the insurance premiums.
Article 3
This Law shall apply to insurance activities within the territory of the People's Republic of China*** and the State.
Article 5
Parties to insurance activities shall exercise their rights and fulfill their obligations in accordance with the principle of honesty and credit.