Medicare reimbursement:
(1) Scope of reimbursement: hospitalization expenses incurred by the insured in the designated hospitals or specialized hospitals of medical insurance of their personal choice, Chinese medicine hospitals and Class A hospitals;
(2) Reimbursement ratio: the starting standard for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization. The payment rate is divided into three grades, with the starting standard for Level III hospitals, for example: 30,000 yuan, 85% for in-service and 91% for retired, 30,000-40,000 90% for in-service and 94% for retired, and more than 40,000 yuan, 95% for in-service and 97% for retired. General hospitalization 90 days as a billing cycle. 360 days for psychiatric hospitalization is a billing cycle, and the starting and ending standards are halved. Maximum payment of 70,000 yuan from the integrated fund in one natural year. The maximum payment for hospitalized large amount is 100,000 yuan, and the payment ratio of hospitalized large amount is always 70%;
(3) Medical management: If the unit pays the fee in full, the individual only needs to pay part of the hospitalization advance payment for hospitalization procedures. The medical expenses incurred should be in line with the scope of the three major directory banks of medical insurance;
(4) reimbursement process: the hospital settles the amount of out-of-pocket expenses and self-payment with the individual at the time of discharge, and the reimbursement amount of the integrated fund will be settled between the hospital and the district medical insurance center.
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