1. Rural areas:
1. Outpatient clinics
Village clinics and village central clinics are reimbursed 60%, with a limit of 10 yuan for prescription drugs per visit. Doctors at health centers have a limit of RMB 50 for temporary rehydration and prescription drugs; town health centers reimburse 40% for visits, a limit of RMB 50 for various examination fees and surgical fees for each visit, and a limit of RMB 100 for prescription drugs; reimbursement for visits to secondary hospitals is 30%, for each visit The examination fee and operation fee limit is 50 yuan, and the prescription drug fee limit is 200 yuan; the reimbursement for tertiary hospital visits is 20%, the examination fee and operation fee limit for each visit is 50 yuan, and the prescription drug fee limit is 200 yuan; the prescription of traditional Chinese medicine is attached to the invoice Each subsidy is limited to 1 yuan; the annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.
2. Hospitalization
Reimbursement scope: medication: auxiliary examinations: electrocardiogram, X-ray, film, laboratory test, physical therapy, acupuncture, CT, MRI There is a limit of 200 yuan for various examination fees; surgery fee. If an elderly person over 60 years old is hospitalized in a health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.
Reimbursement ratio: Town health center reimburses 60%; second-level hospitals reimburse 40%; third-level hospitals reimburse 30%.
3. Serious illness
Any inpatient who participates in the cooperative medical care will be compensated in installments if the one-time or annual cumulative medical expenses exceed 5,000 yuan, that is, 65% of the compensation will be 5,001-10,000 yuan. , 70% compensation for RMB 10,001-18,000. The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.
4. Exemption from liability
Self-seeking medical treatment, self-purchased drugs, drugs that cannot be reimbursed under public medical regulations and medical expenses that are not in compliance with family planning; outpatient treatment fees, consultation fees, hospitalization fees, Food expenses, accompanying guests, nutrition expenses, blood transfusion expenses, heating and cooling expenses, ambulance expenses, special care expenses and other expenses; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents and medical accidents; orthopedics, plastic surgery, dentures, prostheses , organ transplantation, named surgery fees, consultation fees, etc.; within the scope of reimbursement, the portion beyond the limit.
2. Urban residents:
If urban residents are hospitalized for more than two times in one accounting year, starting from the second hospitalization, the minimum fee will no longer be charged. If you are transferred to another hospital or hospitalized for two or more times, the difference will be made up according to the prescribed minimum payment standard for transfer or readmission to the hospital.
3. Students and children
In one accounting year, if medical expenses of less than 180,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 650 yuan, and the reimbursement ratio is 50 %, with an upper limit of 2,000 yuan; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement ratio is 60%; the first-level hospital has no minimum payment standard, and the reimbursement ratio is 65%.
4. Aged 70 and above
In one accounting year, if medical expenses of less than 100,000 yuan are incurred that meet the scope of reimbursement, the minimum payment standard for third-level hospitals is 650 yuan, and reimbursement The proportion is 50%, with an upper limit of 2,000 yuan; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement rate is 60%; the first-level hospital has no minimum payment standard, and the reimbursement rate is 65%.
5. Other urban residents
In one accounting year, if medical expenses of less than 100,000 yuan are incurred within the scope of reimbursement, the minimum payment standard for third-level hospitals is 659 yuan, and the reimbursement ratio is The upper limit of 50% is 2,000 yuan; the minimum payment standard for hospitalization in second-level hospitals is 300 yuan, and the reimbursement ratio is 55%; the first-level hospital has no minimum payment standard, and the reimbursement ratio is 60%.
6. Employees:
Generally speaking, the economic development situation in different regions is different, so the reimbursement ratios are also different. The following is an explanation of the insurance ratio of Beijing employee medical insurance.
After enrolling in medical insurance, if you are an active employee, you can only reimburse for medical expenses of more than 1,800 yuan after going to the hospital's outpatient department or emergency department, and the reimbursement rate is 50%. For retirees under the age of 70, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, 80% of expenses above 1,300 yuan can be reimbursed.
No matter what type of person, the maximum amount of large medical expenses paid for outpatient and emergency services is 20,000 yuan.
For example, if you are an active employee and the cost of outpatient treatment is 2,500 yuan, then 50% of the 500 yuan can be reimbursed, which is 250 yuan.
If it is hospitalization expenses, when the basic medical insurance is used for payment for the first time in 2009, the minimum payment amount is 1,300 yuan for both employees and retirees. For medical expenses for the second and subsequent hospitalizations, the minimum payment standard is determined at 50%, which is 650 yuan. The maximum payment amount from the basic medical insurance pooling fund in one year is 70,000 yuan.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person lives. For example, if the insured person lives in a third-level hospital, the employee pays 15% of the cost from the minimum payment standard to 30,000 yuan, which is 85% of the reimbursement. %; the proportion of personal payment for retirees is 60% of that of active employees, but anything below the minimum payment standard will be paid by individuals.
This is what we know in this area. I hope this article by the editor can help you. If you want to know more about these aspects, you can also search online.