1, cost interval. Above the deductible line to 3000 yuan, the reimbursement ratio is 88%; 3,000 to 5,000 yuan, the reimbursement ratio is 90%; 5,000 to 10000 yuan, and the reimbursement rate is 92%; The reimbursement rate exceeding the maximum payment limit 10000 yuan is 95%.
2. Drug type. The reimbursement rate of Class B drugs is 80%; The reimbursement rate of expensive drugs is 70%; The reimbursement rate of special examination and special treatment expenses is 70%.
Shanxi medical insurance off-site reimbursement process:
1, medical treatment in different places for the record.
2. Selection of designated medical institutions: After the insured completes the medical records in different places, all the inter-provincial networked designated medical institutions opened at the filing place can enjoy the inter-provincial direct settlement service of hospitalization expenses. When seeking medical treatment in outpatient department, we must first understand the regulations on the management of medical treatment in different places in the insured place. If the insured person is required to choose a certain number or purchase medicines in designated inter-provincial networked designated medical institutions at a specified level, it shall be implemented in accordance with the provisions of the insured place.
3. Seek medical treatment with valid certificates: the insured must show valid certificates such as medical insurance electronic certificate or social security card when registering in hospital, settling out of hospital and settling out of clinic. Inter-provincial networked designated medical institutions provide reasonable and standardized diagnosis and treatment and direct settlement of medical expenses for outpatients and inpatients who meet the requirements of diagnosis and treatment places.
4. Reimbursement of expenses: The medical expenses for hospitalization, general outpatient service and outpatient service for chronic diseases and special diseases directly settled in different provinces and different places shall, in principle, be subject to the payment scope and relevant regulations stipulated by the place of medical treatment. If the hospitalization expenses cannot be directly settled after medical treatment in different places for some reason, the expenses shall be reimbursed at the medical insurance handling service window of the insured place according to the regulations.
To sum up, the reimbursement rate of medical insurance in different places in Shanxi Province is adjusted according to the specific situation of the insured and the type of medical treatment, in order to provide more reasonable and convenient settlement services for medical treatment in different places.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.