The reimbursement ratio of medical insurance for urban residents in Changsha has always been a matter of great concern to the local people in Changsha. What is the specific reimbursement ratio of Changsha urban residents’ medical insurance? Almost everyone knows about medical insurance, but this does not mean that all medical insurance expenses can be reimbursed. As for the specific reimbursement amount, what can be said Not much is clear. "Anxiangkangjian" critical illness insurance plan covers cancer in situ and 60 types of critical illness coverage
The coverage of urban residents' medical insurance is wide and complex, and is for those who cannot be included in the coverage of urban employees. It provides basic social security. Since the pilot was launched in 2007, the coverage has been gradually expanded. So far, it basically covers all urban non-employed residents. So what is the reimbursement rate for urban residents who are insured by medical insurance?
The first is the reimbursement ratio of medical insurance for urban residents such as 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 500 yuan, and the reimbursement ratio is 55%; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement ratio is 60%; There is no minimum payment standard for first-level hospitals, and the reimbursement rate is 65%. What are the good critical illness insurances for children? Which ones are cost-effective? Which one is the most worth buying? Let’s take a look at the top-selling critical illness insurance for children from the top 10 insurance companies
The second is the reimbursement ratio of medical insurance for urban residents such as middle-aged and elderly people over 70 years old. In one accounting year, if medical expenses of less than 100,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement ratio is 50%; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement ratio is 60%; There is no minimum payment standard for first-level hospitals, and the reimbursement rate is 65%.
The third is the reimbursement ratio of other urban residents’ medical insurance. In one accounting year, if medical expenses of less than 100,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement rate is 50%; the minimum payment standard for hospitalization in second-level hospitals is 300 yuan, and the reimbursement rate is 55%. ; There is no minimum payment standard for first-level hospitals, and the reimbursement rate is 60%.
According to the relevant person in charge of the Medical Insurance Department of the Changsha Municipal Labor Insurance Bureau, after receiving medical insurance, if you are an active employee, you can only reimburse for medical expenses of more than 2,000 yuan after going to the hospital's outpatient department or emergency department. Changsha The reimbursement rate of urban residents’ medical insurance 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. Regarding the guide to medical insurance reimbursement, I have just compiled relevant content. I hope it will be helpful to you: How to use social security and medical insurance? This article teaches you the reimbursement application process!
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 a year, the minimum payment amount is 1,300 yuan for both working people 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 (hospitalization expenses) in one year is currently 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. %; for expenses ranging from 30,000 yuan to 40,000 yuan, employees pay 10% and 90% is reimbursed; for expenses exceeding 40,000 yuan up to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. The proportion of personal payment for retirees is 60% of that of active (the above-mentioned) employees, but anything below the minimum payment standard is paid by the individual
Almost everyone who goes to the hospital for medical treatment will encounter this situation. , when registering and prescribing medicine, medical staff always ask whether the patient is covered by medical insurance, publicly funded medical care, or self-pay. Is it necessary to "depend on the person" when seeing a doctor and taking medicine? An ophthalmologist at a certain hospital who did not want to be named told reporters that generally speaking, the main reason for asking this question is that the insured people in the medical insurance can only consume what is in the medical insurance directory. Only drugs can be reimbursed. When the curative effects are similar, try to choose drugs that can be reimbursed for the insured.
For self-paying patients, there are more choices.
According to the relevant provisions of the "Changsha Urban Resident Basic Medical Insurance Trial Measures", residents who participated in the urban resident medical insurance before April 30 this year will not have a waiting period for hospitalization. Enjoy monthly benefits. Residents who signed up for insurance after May 1 (including that day) must wait for 3 months before they can enjoy the insurance benefits. However, there is no waiting period for children (under 6 months old) to be insured for hospitalization, that is, they pay the fee in the current month and start enjoying the benefits the following month.
“Currently, we have begun the pilot program of ‘one-stop settlement of residents’ insurance premiums’ in communities such as Jiucaiyuan and Jingwanzi.” The relevant person in charge said that currently, China UnionPay’s card terminal system has started Installed in pilot communities, card swiping terminals are set up in communities and streets, and insured residents can complete insurance and payment at one stop in the community or street.
The medical insurance department is considering improving and adjusting the medical insurance policy and adjusting the reimbursement ratio of Changsha’s urban residents’ medical insurance to allow insured residents to enjoy more benefits. Specific measures will be implemented after being submitted to the municipal government for approval: 1. The first is to increase the reimbursement ratio of medical insurance to more than 50%; the second is to establish a subsidy mechanism for urban residents' basic medical insurance to provide medical assistance to residents who really have financial difficulties; the third is to introduce the management method of urban residents' basic medical insurance home beds to ensure that insured persons seek medical treatment At this time, medical expenses can be saved by setting up home hospital beds or door-to-door medical services; fourth, explore medical expense settlement methods for different groups of people, such as introducing different settlement methods based on the disease expense characteristics of adolescents and children.
Changsha will increase the reimbursement ratio of Changsha urban residents’ medical insurance, and the specific details are currently being reviewed. According to relevant personnel, at the same time, Changsha will further promote the construction industry, entertainment, catering and other service industries to participate in work-related injury insurance, and strive to include all migrant workers who have not participated in medical insurance and work-related injury insurance into the coverage of urban employee medical insurance and work-related injury insurance. "Lekang Wuyou" refundable hospitalization medical insurance plan has the dual functions of insurance protection and premium refund