How much can a medical insurance card reimburse
1, the reimbursement rate: the starting standard for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization. The payment ratio is divided into three grades, with three-level hospitals, for example, the starting standard: 30,000 yuan, 85% of in-service, 91% of retired, 30,000-40,000 90% of in-service, 94% of retired, more than 40,000, 95% of in-service, 97% of retired.
2. 90 days for general hospitalization is a settlement cycle. Psychiatric hospitalization 360 days for a settlement cycle, the starting and ending standards are halved. The maximum payment of 70,000 yuan from the integrated fund in a natural year. The maximum payment for hospitalized large amount is 100,000 yuan, and the payment ratio of hospitalized large amount is always 70%;
3. Reimbursement scope: the hospitalization expenses incurred by the insured in the designated hospitals or specialized hospitals of the medical insurance of personal choice, the Chinese medicine hospitals and the hospitals of category A;
4. Management of medical treatment: If the unit pays the fee in full, the individual only needs to pay part of the hospitalization prepayment for hospitalization procedures. The medical expenses incurred should be in line with the scope of the three major directory banks of medical insurance;
5. Reimbursement process: the hospital settles the amount of out-of-pocket expenses and self-payment with the individual when he is discharged from the hospital, and the amount of reimbursement of the integrated fund will be settled by the hospital and the district medical insurance center.
Expanded Information
Urban residents who are hospitalized for more than two times in one billing year will no longer be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the starting standard of the hospital to which they are transferred or re-admitted.
1. For students and children
In a settlement year, for medical expenses of less than 180,000 RMB incurred that are eligible for reimbursement, the starting standard for a tertiary hospital is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; for a secondary hospital, the starting standard is 300 RMB, with a reimbursement rate of 60%; and for a tertiary hospital, there is no starting standard, with a reimbursement rate of 65%.
2, aged 70 and above
In a settlement year, if the medical expenses of less than 100,000 RMB that meet the scope of reimbursement are incurred, the starting standard for tertiary hospitals is 650 RMB, the reimbursement rate is 50%, and the upper limit is 2,000 RMB; the starting standard for secondary hospitals is 300 RMB, the reimbursement rate is 60%; and the reimbursement rate for first-class hospitals does not have any starting standard, and the reimbursement rate is 65%.
3, other urban residents
In a billing year, incurred in line with the scope of reimbursement of less than 100,000 yuan of medical expenses, the starting standard for tertiary hospitals 659 yuan, the reimbursement rate of 50% capped at 2,000 yuan; second-level hospitals inpatient starting standard of 300 yuan, reimbursement rate of 55%; first-class hospitals do not have a starting standard, the reimbursement rate of 60%.
Baidu Encyclopedia-Medicare Reimbursement Rate