1. Rural
Outpatient
Village health clinics and village center health clinics reimburse 60% of the cost of prescription drugs, each visit is limited to RMB 10 yuan, the health center doctor's temporary rehydration of the cost of prescription drugs is limited to RMB 50 yuan; the township health centers reimburse 40% of the cost, each visit is limited to RMB 50 yuan of the cost of various examinations and The reimbursement for each consultation is limited to RMB 50 yuan for each examination and operation, and RMB 100 yuan for each prescription; 30% for each visit to secondary hospitals, RMB 50 yuan for each examination and operation, and RMB 200 yuan for each prescription; 20% for each visit to tertiary hospitals, RMB 50 yuan for each examination and operation, and RMB 200 yuan for each prescription; RMB 1 yuan per sticker for each prescription attached to a traditional Chinese medicine invoice; and RMB 5000 yuan per year for outpatient reimbursement for township-level cooperative medical service. The annual outpatient compensation for township cooperative medical care is limited to 5,000 yuan.
Hospitalization
Reimbursement scope: medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, MR*** vibration and other examination fees are limited to 200 yuan; surgical fees (with reference to the national standard, reimbursement of fees in excess of 1,000 yuan will be made at the rate of 1,000 yuan.) For elderly people aged 60 or above hospitalized in the health centers, the daily compensation for the treatment fees and nursing care is 10 yuan, with a limit of 200 yuan. yuan, with a limit of 200 yuan.
Reimbursement rates: township health centers reimburse 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.
Major illnesses
Any hospitalized patient who participates in the cooperative medical care system will be compensated for the one-time or yearly accumulative medical expenses of more than 5,000 yuan, i.e., 65% of the 5,001-10,000 yuan, and 70% of the 10,001-18,000 yuan. The annual limit of compensation for inpatient hospitalization and outpatient blood dialysis for uremia, outpatient radiotherapy and chemotherapy for tumors at the township level is 11,000 yuan.
Exemptions
Medical expenses for self-medical treatment (medical treatment in unappointed hospitals or without referral orders), self-acquired medicines, medicines that cannot be reimbursed under the provisions of the public medical care and medical expenses that are not in line with the family planning; outpatient treatment fees, consultation fees, hospitalization fees, meal fees, companion fees, nutritional fees, blood transfusion fees (except for those who have a family blood reserve, which is reimbursed according to the relevant regulations), heating and cooling fees, ambulance fees, special other expenses such as nursing fees; medical expenses for car accidents, fights, suicides, alcoholism, work accidents and medical accidents; orthopedic, cosmetic, dental, prosthetic, organ transplantation, named surgery fees, consultation fees, etc.; reimbursement within the scope of reimbursement, but not outside the limit. [2]
2. Urban
Urban residents who are hospitalized for more than two times in one billing year will no longer be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the starting payment standard of the hospital to which they are transferred or re-admitted.
Students and children
For medical expenses under 180,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for a tertiary hospital is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for a secondary hospital is 300 RMB, with a reimbursement rate of 60%; and there is no starting standard for a tertiary hospital, with a reimbursement rate of 65%.
Age 70 and above
In a billing year, for medical expenses of less than 100,000 yuan that are eligible for reimbursement, the starting standard for a tertiary hospital is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; the starting standard for a second-level hospital is 300 yuan, with a reimbursement rate of 60%; and there is no starting standard for a first-level hospital, with a reimbursement rate of 65%.
Other urban residents
In a billing year, for medical expenses of less than 100,000 RMB incurred that are eligible for reimbursement, the starting standard for third-level hospitals is 659 RMB, with a reimbursement rate of 50% capped at 2,000 RMB; the starting standard for second-level hospitals' inpatient hospitalization is 300 RMB, with a reimbursement rate of 55%; and first-level hospitals do not have a starting standard, with a reimbursement rate of 60%. [3]
3, employees
Generally speaking, the economic development of different regions is different, so the reimbursement rate also varies, the following on the situation of the proportion of employees' health insurance coverage in Beijing.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses of more than 1800 RMB after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and you spend $2,500 on an outpatient visit, you can be reimbursed 50 percent of the $500 portion, which is $250.
In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a 2009 year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is 650 yuan. And the maximum payment amount of the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, that is, 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, and 90% reimbursement; more than 40,000 yuan to the part of the maximum payment limit, it is 95% reimbursement, and the employee only has to pay 5%. And while retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, anything below the starting threshold is paid by the individual.
The diagnostic and therapeutic items that are not paid for by the basic medical insurance for employees are mainly non-clinically necessary and uncertain diagnostic and therapeutic items as well as diagnostic and therapeutic items for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and other categories such as infertility treatments, and so on. In accordance with the "national basic medical insurance treatment program scope", as follows:
(a) service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment expediting fee, surcharge for named surgery, quality and premium fee, self-invited special nurse and other special medical services.
(2) Non-disease treatment program category. (1) a variety of cosmetic, bodybuilding and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height increase program. (3) a variety of health checkups; (4) a variety of preventive, health care treatment programs; (5) a variety of medical consultation, medical appraisal.
(C) diagnostic equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy and other large medical equipment for examination and treatment programs; (2) glasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical.
(D) treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary therapeutic projects.
(v) Others. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.