What is the scope of reimbursement for urban medical insurance in Chongqing?

Medical insurance reimbursement standard for newborn urban and rural residents in Chongqing 1. If the newborn mother has participated in the residents' medical insurance in that year, the newborn can automatically enjoy the residents' medical insurance benefits in that year from the date of birth, and the medical expenses incurred in the year of birth are combined with their mothers until the highest capping line. (In other words, the mother's insurance can be reimbursed as the brand name of the newborn. 2. Newborn mothers who have not participated in residents' medical insurance can enjoy medical insurance benefits by paying the full amount within 3 months after birth from the date of birth. Those born after 3 months shall be insured according to the policy of midway insurance. Chongqing 20 17 medical insurance reimbursement standard for urban residents 1. Ordinary outpatient clinics can be reimbursed in a fixed amount: to put it bluntly, the outpatient fee of 60 yuan can be paid for one year, and it will be gone when it is used up. The useless (or balance) of that year can be accumulated after continuing to participate in the insurance. If there is no continuous insurance, the remaining outpatient expenses will be invalid. 2. The hospitalization reimbursement standard deductible line (that is, the deductible line for each hospitalization): 65,438 yuan+0,000 yuan/time for a first-level medical institution, 2-level 300 yuan/time, and 3-level 800 yuan/time. Top line (i.e. annual reimbursement limit): 80,000 yuan/person/year for the first file and 654.38 yuan+0.2 million yuan/person/year for the second file. The outpatient expenses and hospitalization expenses of major diseases in special diseases are combined to calculate the capping line. (Note: After suffering from special diseases, namely chronic diseases and major diseases, you can also apply for reimbursement for outpatient medical treatment and medicine. Exceeding the quota (60 yuan) 3. The reimbursement standard of medical expenses within the hospitalization policy of insured persons: level I (self-paid 80 yuan): 80% for level I medical institutions, 60% for level II medical institutions and 40% for level III medical institutions. Grade II (paid to 200 yuan): 85% of the first-class medical institutions, 65% of the second-class medical institutions and 45% of the third-class medical institutions. Minors are raised by 5 percentage points on the basis of adults in the same class, that is, the first class (80 yuan): 85% in first-class medical institutions, 65% in second-class medical institutions and 45% in third-class medical institutions. Level II (200 yuan): 90% of the first-level medical institutions, 70% of the second-level medical institutions and 50% of the third-level medical institutions. The maximum annual reimbursement is 654.38+10,000 yuan. According to reports, the proportion of hospitalization reimbursement for first-class insured residents has increased to: 75%-80% for first-class medical institutions, 55%-60% for second-class medical institutions and 35%-40% for third-class medical institutions. The reimbursement rate of the second file is increased by 5% on the basis of the first file. The reimbursement rate increased by 5%- 10% on average. The top line for reimbursement of insured residents in the first file was raised from 30,000 yuan to 60,000 yuan per person per year, and the top line in the second file was raised from 60,000 yuan per person per year to 654.38+10,000 yuan. Three major diseases combined with chemotherapy and analgesia for malignant tumor, dialysis treatment for patients with liver and kidney failure, and anti-rejection treatment after liver and kidney transplantation, the maximum reimbursement per person per year is 6,543,800 yuan. Before the merger, the outpatient department can only reimburse 1 0,000 yuan at most. Newborns can be insured when they land. /kloc-The proportion of hospitalization reimbursement for minors under the age of 0/8 is increased by 5% on the basis of adults of the same age. Hemophilia, aplastic anemia, malignant tumor, dialysis before liver and kidney transplantation, anti-rejection treatment after operation, and severe multiple organ failure are included in the payment scope of major diseases. The reimbursement ratio for outpatient and inpatient services is the same, and the capping line is raised to 654.38+10,000 yuan per person per year for Grade I and150,000 yuan per person per year for Grade II. In addition, newborns can also be insured when they land. If the mother has been insured in that year, the newborn can enjoy medical insurance with the mother, and the expense reimbursement will be calculated together until the highest capping line. If you miss the payment time, you can also pay in full within 3 months of birth (without government financial subsidies), and you can join the insurance independently without waiting period for treatment payment. Residents who miss the payment period can also participate in the insurance halfway. Generally, they pay the medical insurance fee for the next year every June10-June 12. If you missed the payment time before, you can't join the insurance halfway. In the future, residents are allowed to participate in the insurance midway, but they need to pay the full insurance premium of the year (no government financial subsidy). In order to avoid someone taking the opportunity to "exploit loopholes", a three-month waiting period for benefit payment is specially set, that is, medical expenses cannot be reimbursed within three months after payment. The reporter learned from the Chongqing Municipal Bureau of Human Resources and Social Security that in 20 16 years, the individual payment standard for urban and rural residents participating in residents' medical insurance in our city will be adjusted to 1 10 yuan per person per year, and the 280 yuan per person per year in the second category will be higher than that in 30 yuan and 80 yuan respectively. At the same time, from next year, the general outpatient expenses of primary medical care can be reimbursed in proportion. The individual payment standard for residents' medical insurance will rise next year. According to the regulations, urban and rural residents who have registered in this city and have not participated in medical insurance for urban workers include students attending primary and secondary schools, secondary vocational schools, special education schools and kindergarten children (hereinafter referred to as urban and rural residents); Full-time undergraduates, junior college students and graduate students in Chongqing universities (hereinafter referred to as college students); Newborns born on 20 16 and registered in this city (hereinafter referred to as newborns) can participate in the medical insurance for residents in this city. Compared with this year, in 20 16, the individual payment standard of urban and rural residents participating in residents' medical insurance in our city has been improved, among which the first file is 1 10 yuan per person per year, which is higher than 80 yuan this year, and the second file is 280 yuan per person per year, which is higher than 200 yuan this year. The individual payment standard for college students in Chongqing to participate in the academic year from September 2005 to August 2006 is: 80 yuan per year for the first class and 200 yuan per year for the second class. The centralized payment time for urban and rural residents is from September this year to 65438+February. According to the Municipal Bureau of Human Resources and Social Security, the centralized payment time for urban and rural residents is from September 20 15 to June 65438+February. Urban and rural residents who miss the centralized payment period can participate in the insurance payment before September 30, 2006. College students participated in residents' medical insurance in our city from September, 20 15 to August, 20 16, and the payment time was within 60 days after the start of school in autumn, 20 15. The time for newborns to apply for independent insurance compensation is within 90 days from the date of birth. Urban and rural residents who participated in insurance payment from September 20 15 to February 20 161231; Those who pay the insurance premium in 1 6,65438 10 and February will enjoy the treatment from June1,20 16,12,31in the next month of payment; Those who pay the insurance premium after 20 16, 1 March need to wait 90 days to enjoy the residents' medical insurance benefits until 20 16, 3 1 February. College students who apply for insurance and pay fees within 60 days after the start of the fall semester on 20 15 will enjoy the benefits from September 20 15 to August 20 16. Newborns who pay their own fees enjoy treatment from the day of birth -20 16 12 3 1. Newborns who are not independently insured can enjoy the residents' medical insurance benefits of that year with their mothers who participate in residents' medical insurance from the date of birth. From next year, the general outpatient expenses of primary medical care can be reimbursed according to the proportion of the general outpatient expenses of residents' medical insurance. How to reimburse the general outpatient expenses? According to the Municipal Bureau of Human Resources and Social Security, the general outpatient expenses incurred by residents participating in medical insurance can be covered by the general outpatient quota, and the quota of 20 16 is 80 yuan per person. The fixed lump sum fund can be used for the insured person, relatives or designated personnel to purchase outpatient treatment drugs or pay hospitalization expenses. The unused balance of the current year can be carried forward across years. Insured personnel can use it within the quota of general outpatient service, and the reimbursement ratio is 100%. The insured should pay attention to the fact that the fixed lump sum fund for general outpatient service belongs to the residents' medical insurance fund, not to individuals. For residents who do not have continuous insurance contributions, unused fixed lump sum funds will no longer be carried forward. In 20 16, residents' medical insurance in our city added medical insurance benefits: according to the relevant requirements of the state for establishing general outpatient service, from 20 16, our city will establish a reimbursement system for residents' medical insurance general outpatient service in primary medical institutions. On the basis of fixed contract, the expenses incurred by the insured in the general outpatient service of township hospitals, community service centers, village clinics, community service stations and other grassroots medical institutions and social medical institutions below the first level can be reimbursed by the residents' medical insurance fund according to a certain proportion. The specific measures shall be implemented after being approved by the Municipal Human Resources and Social Security Bureau, the Municipal Finance Bureau and the Municipal Health and Family Planning Commission.