The proportion of hospitalization reimbursement for urban residents' medical insurance is as follows:
1, students and children (1less than 0.8 million yuan); The reimbursement rate of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 60%; The reimbursement rate of first-class hospitals is 65%;
Older people over 2.70 years old (below 654.38+ 10,000 yuan); The reimbursement rate of tertiary hospitals is 50%; The reimbursement rate of secondary hospitals is 60%; The reimbursement rate of first-class hospitals is 65%;
3. Other urban residents (less than 6,543,800 yuan); The reimbursement rate of tertiary hospitals is 50%; The reimbursement rate of secondary hospitals is 55%; The reimbursement rate of first-class hospitals is 60%.
How to reimburse medical insurance in different places
1, reimbursement in different places (refer to the province).
First of all, call the Social Security Bureau for the specific reimbursement policy of the new rural cooperative medical system, issue a referral form in the local hospital, and then go to the local Social Security Bureau for filing. Then, after going through the hospitalization formalities in the superior hospital, you can get the reimbursement subsidy directly after you leave the hospital.
2, remote reimbursement (referral outside the province).
Assuming that the deductible line for medical treatment outside the province is 2000 yuan, the compensation ratio is 35%~65%, but considering the inconsistency of reimbursement policies in different places, the actual compensation ratio may be lower after all calculations. I would like to remind you that the referral certificate is not so easy to open, and the condition is usually that there is no local equipment to treat this disease, so it will be easy to refer from the county to a higher-level hospital. However, it is very difficult to refer from the provincial capital city hospital to Beijing.
3, remote reimbursement (non referral).
Considering that there are many restrictions on referral, many people go to other cities for medical treatment without referral. Then, according to the example of Laos, if referral is not considered, the actual reimbursement rate may not even be 35%, and the reimbursement rate will only be between 0% and 35%.
If the employee medical insurance is used to calculate, suppose that in Shenzhen, the reimbursement rate is 90%, and the hospitalization expenses incurred without referral should be paid in cash first, and then the reimbursement rate will be reduced by 30% according to relevant documents. For those who have not been referred to the mainland for medical treatment, the hospitalization medical expenses incurred in designated hospitals outside Shenzhen can be directly reimbursed by medical insurance cards, and the reimbursement ratio is reduced by 10 percentage point.
The reimbursement rate of urban hospitalization medical expenses is: 70% for first-class medical institutions (including community health service centers), 60% for second-class medical institutions and 50% for third-class medical institutions.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units. second
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.