According to the level of hospitalization expenses, the reimbursement rate is: 1.300 yuan-30,000 yuan (inclusive), 85% 30,000 yuan-40,000 yuan (inclusive), and the reimbursement rate is 90%.
Proportion of medical insurance reimbursement in five insurances:
First, the proportion of hospitalization reimbursement
1. First-class hospital, the part above Qifubiaozhun is up to 90% of the maximum payment limit;
2. Secondary hospitals pay 85% of the minimum deductible line 1 10,000 yuan and 90% of the maximum payment limit 1 10,000 yuan;
3. 80% will be paid for the minimum deductible of 5,000 yuan, 85% for the minimum deductible of 5,000 yuan to 1 10,000 yuan, and 90% for the maximum payment limit of 1 10,000 yuan.
4. Retirees will increase by 5% on the basis of the above payment ratio.
Second, hospitalization reimbursement deductible line
1. Level I Hospital 200 yuan;
2.500 yuan, a secondary hospital;
3.800 yuan, a tertiary hospital;
4. For patients with malignant tumor, medical expenses incurred by radiotherapy and chemotherapy for many times in a medical year are deductible only once.
Third, the proportion of outpatient reimbursement for chronic diseases.
Outpatient chronic diseases are divided into Class A chronic diseases and Class B chronic diseases.
1. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The cost of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure further increased by 10 percentage point.
2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and the maximum payment limit for chronic diseases shall not be exceeded within one medical year.
3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the first identified double diseases, and calculate the deductible for each disease separately. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.
Fourth, the maximum amount of medical insurance reimbursement
In a medical year, the hospitalization medical expenses and chronic disease outpatient medical expenses paid by the overall fund cannot exceed the maximum payment limit. The maximum payment limit of the overall fund is 250,000 yuan. The municipal administrative department of human resources and social security shall timely adjust the Qifubiaozhun and the maximum payment limit of the overall fund according to the wage level of employees and the income and expenditure of the overall fund.
Legal basis:
Article 27 of People's Republic of China (PRC) Social Insurance Law
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.