1 and the reimbursement rate of tertiary hospitals is 55%;
2. The reimbursement rate of secondary hospitals is 60%;
3. The reimbursement rate of the first-level hospital is 65%.
Two, the elderly over 70 years old (654.38+ ten thousand yuan)
1 and the reimbursement rate of tertiary hospitals is 50%;
2. The reimbursement rate of secondary hospitals is 60%;
3. The reimbursement rate of the first-level hospital is 65%.
Three, other urban residents (6.5438+ten thousand yuan)
1 and the reimbursement rate of tertiary hospitals is 50%;
2. The reimbursement rate of secondary hospitals is 55%;
3. The reimbursement rate of the first-level hospital is 60%.
Fourth, the proportion of employee medical insurance reimbursement.
Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. Let's explain the proportion of medical insurance for employees in Beijing.
After receiving medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed, and the reimbursement rate is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.
No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if an on-the-job worker spends 2,500 yuan in outpatient service, then 700 yuan can reimburse 50%, that is, 350 yuan.
If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 yuan.
The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.
The medical treatment items that employees' basic medical insurance does not pay are mainly those that are clinically unnecessary and have uncertain curative effects, and those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other types of infertility treatment.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.