Medical reimbursement is only divided into rural residents and urban workers, and has nothing to do with whether or not they are poor households and whether or not they hold a low income guarantee. Reimbursement rates: 1. Reimbursement rates for residents: 60 for town health centers; 40 for second-level hospitals; and 30 for third-level hospitals. 2. For urban residents, for medical expenses up to 100,000 yuan eligible for reimbursement within a billing year, the starting standard for third-level hospitals is 659 yuan, and the reimbursement rate is 50 up to the maximum of yuan; for second-level hospitals, the starting standard for inpatient hospitalization is 300 yuan, and the reimbursement rate is 55; for first-level Hospitals do not set the starting standard, the reimbursement rate of 60.
Medicare card reimbursement process is as follows: 1, medical insurance hospitalization, show your medical card, read the card into the medical insurance system, pay the deposit (usually the threshold fee); 2, incurred costs entered into the system, the system is automatically categorized as out-of-pocket expenses, Category A, Category B, etc., Category B first out-of-pocket payment of 10, and then into the basic medical care, according to the number of times of the year hospitalization (greater than 1 threshold fee halved), hospital level (threshold fee of different levels), and hospital level (threshold fee of different levels), and then into the basic medical care. ), hospital level (threshold fee is different, the overall percentage is different); 3, by the computer to calculate how much they should pay, the hospital and then to the social security of the medical insurance center to settle how much money.
What are the items included in the reimbursement
The reimbursement categories and items included in the reimbursement are as follows:
1, general medical insurance. It mainly includes outpatient costs, medical costs, examination costs and so on.
2. Hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, surgery cost, medicine cost and so on.
3. Surgical insurance. Provides for all expenses incurred due to necessary surgery required by the patient.
4. Comprehensive medical insurance. Its cost coverage includes all costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic cost payment, the average resident family can hardly afford. Examples include cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
I hope the above can help you, if you have other questions please consult a professional lawyer.
Legal basis: "medical insurance fund use supervision and management regulations"
Article 8 of the medical insurance fund shall be used in accordance with the scope of payment of the state regulations. Medical insurance fund payment scope by the state council administrative department of medical insurance organization in accordance with the law. The people's governments of provinces, autonomous regions and municipalities directly under the Central Government in accordance with the authority and procedures prescribed by the state, supplemented by the development of specific items and standards for payment by the medical insurance fund in the administrative region, and reported to the State Council's administrative department of medical insurance for the record.
Article 9 of the state to establish and improve the national unified medical insurance management system, to provide standardized and standardized medical insurance management services, to achieve full coverage of provinces, cities, counties, townships (streets), villages (communities). Article 30 of the Social Insurance Law of the People's Republic of China*** and the State of China, the following medical expenses are not included in the scope of payment of the basic medical insurance fund:
(1) those that should be paid from the Workers' Compensation Insurance Fund;
(2) those that should be borne by a third party;
(3) those that should be borne by public*** health;
(4) those that are sought outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party does not pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.