I. Urban Employee Basic Medical Insurance and Employee Large Medical Expense Subsidies (1) Outpatient 1. Specialty Disease Outpatient: Starting standard is 200 RMB, and reimbursement is made in accordance with the reimbursement ratio of ordinary hospitalization in the same level of medical institutions. 2. Chronic disease outpatient: starting standard 200 yuan, 82% reimbursement for active employees, 91% reimbursement for retirees. (B) General hospitalization 1. Starting standard: 100 yuan for community health centers, 200 yuan for first-level medical institutions, 400 yuan for second-level medical institutions, 800 yuan for third-level medical institutions, and 50% of the normal starting standard for the second and subsequent hospitalizations within the year. 2. Reimbursement ratio: above the starting standard, community health centers and first-class medical institutions reimburse 88% of active employees and 94% of retirees; second-class medical institutions reimburse 84% of active employees and 92% of retirees; third-class medical institutions reimburse 82% of active employees and 91% of retirees. 3. Annual maximum payment limit: 80,000 yuan. (C) Hospitalization of foreign referral The starting standard is 2000 RMB, and the reimbursement rate is 67%. (4) Emergency hospitalization in other places refer to the treatment standards of the highest level of medical institutions in the city to be settled. (5) Temporary hospitalization outside of the city The starting standard is 3,000 yuan, and the reimbursement rate is 52%. (F) the foreign resettlement of retirees, foreign long-term residents, permanent staff hospitalized in a foreign place the above people for the record of the province for medical treatment in a foreign place, retaining the insured place of direct settlement of ordinary hospitalization, the starting line and reimbursement within the policy according to the standards of the same level of health care institutions in the city; these people for the record of the foreign medical treatment outside of the province, the starting line and the policy reimbursement according to the standards of the same level of health care institutions in the city.
These are the first time I've ever seen a medical institution in the city.
(VII) Employee subsidies for large medical expenses Included in the employee subsidies for large medical expenses of compliance with the medical expenses, the contractor's commercial insurance company to pay 90% of the maximum payment limit of 470,000 yuan for the settlement year. Second, the basic medical insurance for urban and rural residents and major medical insurance (a) outpatient 1. Basic outpatient: no starting line, reimbursement rate of 80%, the annual maximum payment limit of 50 yuan. 2. General outpatient: starting standard 25 yuan / quarter, reimbursement rate of 60%, of which the second-level medical institutions (public) pediatrics clinic, hypertension, diabetes reimbursement rate of 50%, the maximum payment limit of 400 yuan / year. 3. "Two diseases" outpatient: starting standard 25 yuan / year (combined with general outpatient), in the agreement management of community health centers, township health centers, first-class and second-class public medical institutions incurred "two diseases" outpatient drug costs, reimbursement rate of 50%. The reimbursement rate is 50%. On the basis of the general outpatient payment limit, the annual payment limit of the hypertension fund is 240 yuan, and the annual payment limit of the diabetes fund is 300 yuan. 4. Special disease outpatient: starting standard 200 yuan / year, the reimbursement rate in accordance with the same level of medical institutions hospitalization reimbursement standards. 5. Chronic disease outpatient: starting standard 200 yuan/year, reimbursement rate of 70%. (B) General hospitalization 1. Starting standard: 100 yuan for first-level medical institutions, 200 yuan for second-level medical institutions, 800 yuan for third-level medical institutions (400 yuan for minors), the starting standard for the second and subsequent hospitalizations within the year, according to the implementation of 50% of the normal starting standard. 2. Reimbursement rate: 80% for the first level of medical institutions above the starting standard, 75% for the second level of medical institutions, and 65% for the third level of medical institutions. 3. Annual maximum payment limit: 80,000 yuan. (C) Hospitalization of foreign referral The starting standard is 1500 RMB, and the reimbursement rate is 50%. (4) Emergency hospitalization in other places refer to the treatment standards of the highest level of medical institutions in the city to be settled. (5) Temporary hospitalization The starting standard is 2,000 yuan, and the reimbursement rate is 35%. (f) The hospitalization of retirees resettled in other places, long-term residents in other places and permanent staff in other places is the same as the basic medical insurance policy for urban workers. (VII) major medical insurance 2022 starting standard 12,000 yuan, urban and rural people in need of starting standard for 50% of the normal starting standard, starting standard above, 0-5,000 yuan reimbursement of 60%, 50,000 yuan -100,000 yuan reimbursement of 65%, more than 100,000 yuan reimbursement of 70%, in which urban and rural people in need of reimbursement for a unified ratio of 70%. The reimbursement amount of the major medical insurance is not set a ceiling line. Third, maternity insurance (a) maternity medical expenses 1. Participating in the basic medical insurance female participants in the designated medical institutions in line with the relevant national policies and regulations of the maternity hospitalization medical expenses included in the scope of payment of the integrated fund, the implementation of the limit of payment, the limit of the standard of 2200 yuan for a difficult birth, the limit of the standard of cesarean section of 3300 yuan for multiple births, each additional birth increase of 300 yuan, the limit of 300 yuan. The limit for multiple births will be increased by 300 yuan for each additional birth, and if the standardized medical expenses incurred are lower than the above standard, they will be paid in accordance with the actual incurred expenses. 2. The limit of medical expenses for family planning surgery is 400 yuan for abortion, 800 yuan for induced abortion and 300 yuan for IUD. (2) Maternity allowance The average monthly salary of the employee in the previous year determines the basis of maternity allowance, and the cost of maternity allowance is calculated according to the number of days of maternity leave. Fourth, medical assistance (a) the scope of subsidies low income recipients, special hardship cases (including orphans and de facto unsupported children) and low income marginal family members. (2) Subsidy standards Low-income objects, special hardship cases to participate in the urban and rural residents of the basic medical insurance individual contributions to the full amount of subsidies, low-income marginalized members of the family to a fixed amount of subsidies. (C) enjoy the treatment standards 1. Hospitalization assistance: urban and rural residents medical insurance integrated fund to pay for the project of the medical costs borne by individuals (including hospitalization costs of the starting line, the same below), low-income recipients, special hardship case 70% of the assistance, the maximum limit of 10,000 yuan per person per year for general diseases, the maximum limit of 20,000 yuan per person per year for serious and serious illnesses, the marginal members of the low-income families, other special hardship case 50% of the assistance to be given. The maximum annual limit for general diseases is RMB 10,000 per person, and the maximum annual limit for serious diseases is RMB 20,000 per person, while the maximum annual limit for marginal members of the low-income group and other people in special difficulties is RMB 50,000 per person. Low-income and special hardship cases who are covered by urban workers' medical insurance will be given 50% of the assistance, with a maximum of 0.3 million yuan per person per year for general illnesses and 0.5 million yuan per person per year for serious and serious illnesses. Major diseases include childhood leukemia, congenital heart disease, women's breast cancer, cervical cancer, severe mental illness, uremia (including hemodialysis), multidrug-resistant tuberculosis, AIDS opportunistic infections, etc. *** 8 kinds. 2. General outpatient assistance: in the designated medical institutions for treatment of low-income recipients, special hardship cases at 60% of the assistance, the maximum annual limit of 100 yuan per person. 3. Special disease outpatient assistance: do not need hospitalization, cancer patients need regular outpatient radiotherapy after surgery, uremia patients need regular outpatient dialysis (hemodialysis or peritoneal dialysis), organ transplant patients need to take medication on a regular basis in order to combat rejection of the aid recipients in the designated medical institutions to enjoy the urban and rural residents' medical insurance special disease outpatient treatment, urban and rural residents' medical insurance coordinating fund to pay for the project of individual medical costs borne by the low income people, the low income people will be given 60% assistance. For the medical expenses borne by the low-income and special-needs persons, 70% of the assistance will be given to them, with a maximum of 10,000 yuan per person per year, and 20,000 yuan per person per year for serious and serious illnesses. Low-income marginal family members, other special hardship cases by 50% to give assistance, general illnesses per person per year up to a maximum limit of 0.6 million yuan, the maximum limit of major diseases per person per year up to 15,000 yuan. 4. Transfer, emergency relief: urban and rural poor residents hospitalized due to sudden illness (in non-scheduled hospitals), in the enjoyment of urban and rural residents health insurance treatment, medical insurance policy within the scope of the individual's share of the medical costs (including the starting standard), approved by the urban and rural residents medical insurance, in accordance with the standard relief of scheduled hospitals. (D) patients with severe mental disorders medical assistance 1. Medical assistance scope: diagnosed by the mental health medical institutions suffering from severe mental disorders requiring hospitalization in urban and rural people in need of hospitalization in the designated medical institutions, its compliance with the medical costs by the basic health insurance for urban and rural workers, urban and rural residents and basic medical insurance and major medical insurance payments, medical assistance and then according to the hospital bed to give a fixed amount. The medical aid will be given on a flat-rate basis for each hospitalized bed day. 2. The standard of medical aid: 20 RMB/day for each bed in first and second class hospitals, and 30 RMB/day for each bed in third class hospitals. Individuals no longer bear the cost of medical care in line with the urban and rural Jinzhou basic medical insurance drug catalog, diagnostic and treatment items and medical service facilities within the scope of the directory, the basic medical insurance coverage of the part of the individual's responsibility for compliance with the medical costs borne by the basic medical insurance designated medical institutions. V. Medical insurance to help the poor Establishment of basic medical insurance, major disease insurance, consolidate the results of poverty alleviation counties (cities, districts) medical supplemental insurance, medical assistance protection mechanism. 1. Basic medical insurance On the basis of the basic medical insurance policy, the urban and rural residents applying for basic medical insurance for urban and rural people in need of identification of chronic diseases to open a green channel. 2. Major Disease Insurance The starting line of the major disease insurance for urban and rural people in difficulty is 50% of the normal starting line, and the payment ratio is increased to 70%, with no ceiling line. 3. Consolidation of the results of poverty alleviation counties (cities and districts) medical supplemental insurance The relevant policies are subject to the interpretation of the poverty alleviation department. 4. Medical assistance in accordance with the relevant policies of medical assistance. VI. Other 1. The age of 75 years old chronic disease treatment entitlement is no longer re-examined. 2. Strengthen the level of medical protection for newborns. Newborns within 90 days of birth by their guardians for registration and timely payment, from the date of birth to enjoy the participating urban and rural residents of basic medical insurance, major medical insurance treatment; for the 90 days after birth due to the death of newborns due to invalid treatment of inpatient medical expenses incurred by their parents with the relevant materials, to the participating health insurance agencies in accordance with the provisions of the replacement of registration and payment formalities and the settlement of medical expenses. 3. The outpatient expenses of children with phenylketonuria for diagnosis and treatment, special diets, and special medicines are included in the scope of payment of major disease insurance. There is no starting line, reimbursement rate of 70%, the limit standard for each age: 0 years old 15,000 yuan, 1-3 years old 18,000 yuan, 4-10 years old 24,000 yuan, 11-18 years old 30,000 yuan (0 years of age refers to the year of birth, and every subsequent increase of one year across one year of natural growth up to the age of 18 years). 4. Increase aplastic anemia and other 10 kinds of children's blood diseases, malignant tumors, children's major disease insurance tilt. The reimbursement rate will be increased to 70% without a ceiling. 5. Improve the level of treatment for hemophiliacs with chronic diseases. Alternative treatment process, human coagulation factor VIII and limited hemophilia use of drugs are all included in the scope of payment; urban workers basic medical insurance hemophilia chronic disease subsidy standard from the original 670 yuan / month to 12,000 yuan / quarter, urban and rural residents basic medical insurance hemophilia chronic disease subsidy standard from the original 500 yuan / month to 9,600 yuan / quarter. 6. Expand the scope of auxiliary drugs for uremia dialysis patients and improve the treatment level of patients with chronic hepatitis C antiviral treatment. The basic medical insurance drug catalog of Liaoning Province, "vitamin B12 and folic acid", "hyperkalemia and hyperphosphatemia treatment drugs" category of drugs and limited dialysis drugs are all included in the uremia outpatient dialysis treatment drug payment scope; will be the "chronic hepatitis C" antiviral treatment patients. The category of "chronic hepatitis C interferon antiviral treatment" has been adjusted to "chronic hepatitis C antiviral treatment", and at the same time, three hepatitis C antiviral drugs, namely, Elbasvir Grapevir, Ledipavir Sofosbuvir, and Sofosbuvir Vepatasvir, have been incorporated into the scope of reimbursement for chronic diseases. 6. 7. Eliminate the restrictions on participation in the city's basic health insurance household registration, the city's household registration and non-local residents with the city's residence permit can voluntarily choose to participate in the city's employee health insurance or residential health insurance. 8. Cancellation of chronic disease patients can only be in a designated medical institutions within the year to enjoy the chronic disease outpatient integrated treatment restrictions, you can according to the needs of all chronic disease outpatient integrated designated medical institutions in the city to enjoy the corresponding chronic disease outpatient integrated treatment. 9. Urban and rural residents of the basic health insurance students to participate in tilted policy (1) the city's newly enrolled students of all levels and types in the current year prepayment period with the school enrolled in the payment of health insurance premiums for the next year, from September 1 of that year to enjoy the urban and rural residents of the basic health insurance treatment. (2) All levels and types of students participating in the city's residents' health insurance accidental injury, in the absence of a third-party burden, can normally enjoy the city's residents' health insurance treatment. (3) College (secondary) and university students in the rest days, legal holidays, winter and summer vacations, or due to illness during the suspension of hospitalization in the place of domicile, internship internship hospitalization, on behalf of the school during the hospitalization in the place of hospitalization occurred within the scope of the residents' medical insurance policy to pay for the medical costs, you can apply for the record of medical treatment in a different place, hospitalization in accordance with the standards of the city to pay for treatment. If you need to be hospitalized due to illness, you can voluntarily choose to seek medical treatment at the hospital in your place of domicile or your place of study, and you can apply for registration of off-site medical treatment for the record, and payment will be made in accordance with the standard of hospitalization in the city. Due to the limitations of medical conditions in the place of domicile need to be transferred to other areas for treatment, the hospitalization medical expenses incurred by the hospital in the place of domicile for the transfer procedures will be paid according to the standard of hospitalization treatment in a different place of referral.Administrative Measures for the Settlement of Foreign Medical Treatment
I. Foreign Medical Referral Participants who need to leave the city for hospitalization due to illnesses that satisfy the "Jinzhou City Basic Medical Insurance Referral Catalogue of Diseases and Diagnostic and Therapeutic Items" do not need to be certified by a designated medical institution, and the participant will be entitled to a medical certificate of referral. Referral certificate, the participant's local office based on medical records and other materials directly for the participant to handle the referral record. For diseases that are not included in the catalog and diagnostic and therapeutic items and cannot be diagnosed or treated due to the medical technology or diagnostic and therapeutic equipment capacity of the city's referral hospitals, the designated designated referral medical institutions will issue certificates for the record, and the counties (cities) will be responsible for the referral of the insured to hospitals within their administrative districts.
Jinzhou City Medical Insurance designated referral list of medical institutions
No. Name of the medical institution Remarks 1 The First Affiliated Hospital of Jinzhou Medical University No infectious diseases, tuberculosis, mental illness 2 Jinzhou City Central Hospital No infectious diseases, Tuberculosis, mental illness 3 The Third Affiliated Hospital of Jinzhou Medical University No infectious diseases, tuberculosis, mental illness 4 The Chinese People's Liberation Army Hospital No. 968 No infectious diseases, tuberculosis, mental illness 5 Jinzhou City Corning Hospital Mental illnesses only 6 Jinzhou City Infectious Diseases Hospital Infectious diseases, tuberculosis only 7 Jinzhou Women's and Infants' Hospital Obstetrics and Gynecology, Pediatrics only 8 Montenegro County People's Hospital Infectious diseases, tuberculosis, mental illnesses are not included 9 Beizhen People's Hospital Infectious diseases, tuberculosis, mental illnesses are not included 10 Linghai People's Hospital 11 Yi County People's Hospital Second, temporary out-of-town hospitalization Temporary out-of-town hospitalization refers to the temporary out-of-town hospitalization of the insured person who needs hospitalization in a designated medical institution of foreign health insurance due to illness, and who applies for it by himself/herself, and after registering at the health insurance administration organization, goes to a designated medical institution of foreign health insurance in the city of Beijing. The hospitalized persons who need to be hospitalized in the designated medical institutions of other places during the period of going out due to illness. Temporary out of the hospital personnel for the record after the completion of the immediate effect of the validity of 60 days, when the hospitalization is valid, the validity of the participant shall not change the place of medical treatment, the expiration of the automatic expiration of the participant can re-apply for the record. Third, the emergency emergency Participants in the city or for health insurance for the record of people living in a different place to leave the record of residence, due to a sudden critical illness and to meet the "basic medical insurance critical illnesses settlement reference diseases and key standards", you can be in a designated medical institution in a different place after emergency admission to the hospital with medical records and other materials to apply for the record before discharge, and direct settlement. The settlement of medical expenses for critical illnesses in other places, with reference to the treatment standards of the city's highest-ranking medical institutions to be settled.&nbs