I. Overview of the proportion of medical insurance reimbursement
In Heilongjiang province, the proportion of medical insurance reimbursement is usually divided according to the type of medical expenses, the nature of treatment items and the identity of insured persons. Generally speaking, medical insurance can cover most basic medical expenses, including hospitalization expenses, surgery expenses, medicine expenses and so on. However, for some special projects or high-end medical services, the proportion of medical insurance reimbursement may be reduced or patients have to bear part of the expenses themselves.
Second, the reimbursement ratio of different medical items.
Hospitalization expenses: The proportion of hospitalization expenses reimbursed by medical insurance in Heilongjiang Province is usually high, but the specific proportion will vary according to the level of the hospital and the type of patients participating in the insurance. Generally speaking, the reimbursement rate of tertiary hospitals will be lower, while the reimbursement rate of primary medical institutions will be higher.
Medical expenses: Medical insurance reimbursement for medical expenses also varies according to the types and prices of medicines. Generally speaking, the reimbursement rate of commonly used drugs and essential drugs is high, while some imported drugs and high-end drugs may have a low reimbursement rate or require patients to pay their own expenses.
Special treatment items: For some special treatment items, such as organ transplantation and high-end examination, the proportion of medical insurance reimbursement may be limited. These projects usually require patients to bear a high proportion of their own expenses.
Thirdly, the influence of the identity of the insured on the reimbursement ratio.
In Heilongjiang province, the proportion of medical insurance reimbursement enjoyed by insured persons with different identities will be different. Generally speaking, the proportion of medical insurance reimbursement for urban workers is higher, and the medical insurance for urban and rural residents is slightly lower. In addition, the government will give certain medical assistance and subsidies to special groups such as the poor elderly.
To sum up:
In 2024, the reimbursement rate of medical insurance in Heilongjiang will be different according to different policies and medical projects, and the reimbursement rate of different insured people will be different. When patients enjoy medical insurance reimbursement, they need to inquire and confirm according to their actual situation and types of medical expenses, so as to better understand their medical security rights and interests. At the same time, the government is constantly improving the medical insurance policy, increasing the proportion of medical insurance reimbursement and reducing the burden of medical expenses for the people.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.
Interim Provisions of Heilongjiang Province on Basic Medical Insurance for Urban Workers
Article 12 stipulates:
The medical expenses paid by the basic medical insurance fund must conform to the provisions of the scope of basic medical insurance drugs, diagnosis and treatment items, medical service facilities and payment standards.
Measures for the implementation of basic medical insurance for urban and rural residents in Heilongjiang Province
Article 14 stipulates:
Insured residents in designated medical institutions in accordance with the provisions of the hospitalization expenses, Qifubiaozhun below paid by individuals; The expenses above Qifubiaozhun and below the maximum payment limit shall be shared by the medical insurance fund and individual insured residents according to the prescribed proportion.