Yi, rural medical insurance insurance ratio
1, outpatient
Village health clinic and village center health clinic visit reimbursement of 60%, each visit to the prescription drug fee limit of 10 yuan, the health center doctor temporary rehydration prescription drug fee limit of 50 yuan;
Township health center visit reimbursement of 40%, each visit to the examination fee and surgical fee limit of 50 yuan, prescription drug fee limit of 100 yuan;
Second-level hospital visit reimbursement of 30%, each visit to the examination fee and surgery fee limit of 50 yuan, the prescription drug fee Limit 100 yuan;
30% reimbursement for secondary hospital visits, with a limit of 50 yuan per visit for each examination and surgery, and a limit of 200 yuan for prescription medication;
20% reimbursement for tertiary hospital visits, with a limit of 50 yuan per visit for each examination and surgery, and a limit of 200 yuan for prescription medication;
Limit of 1 yuan for each sticker of traditional Chinese medicines attached to the invoice for the prescription; and an annual limit of 1 yuan for cooperative medical outpatient reimbursement at the township level. Cooperative medical outpatient reimbursement annual limit of 5000 yuan
2, hospitalization reimbursement scope:
Medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit 200 yuan;
Surgery (with reference to the national standard, more than 1000 yuan reimbursement of 1000 yuan). 60 years old or older in the health center hospitalized in the hospital, the elderly people over the age of 60 years old in the health center limit 50 yuan. elderly people over the age of one week are hospitalized in health centers, the treatment and nursing fees are compensated at 10 yuan per day, with a limit of 200 yuan.
Reimbursement rates: town health centers reimburse 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.
3. Major Diseases
Any hospitalized patient who participates in the cooperative medical care system will be reimbursed for the one-time or yearly cumulative reportable 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.
Town-level cooperative medical inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy compensation annual limit of 11,000 yuan.
Two, the proportion of medical insurance coverage for town residents
Town residents who are hospitalized for more than two times in a 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 standard of the hospital to which they are transferred or to which they are re-admitted.
1. For students and children
In a settlement year, for medical expenses of less than 180,000 RMB incurred that are eligible for reimbursement, the starting standard for Level III hospitals is 650 RMB, and the reimbursement rate is 50%, with a ceiling of 2,000 RMB; the starting standard for Level II hospitals is 300 RMB, and the reimbursement rate is 60%; and Level I hospitals do not have a starting standard, and the reimbursement rate is 65%.
2, aged 70 and above
In a settlement year, if the medical expenses of less than 100,000 RMB that meet the scope of reimbursement are incurred, the starting standard for tertiary hospitals is 650 RMB, the reimbursement rate is 50%, and the upper limit is 2,000 RMB; for secondary hospitals, the starting standard is 300 RMB, and the reimbursement rate is 60%; and for first-class hospitals, there is no starting standard, and the reimbursement rate is 65%.
3. For other urban residents
In a billing year, if they incur medical expenses under 100,000 yuan that are eligible for reimbursement, the starting standard for third-level hospitals is 659 yuan, and the reimbursement rate is 50% with an upper limit of 2,000 yuan; the starting standard for second-level hospitals' inpatient hospitalization is 300 yuan, and the reimbursement rate is 55%; and the reimbursement rate for first-level hospitals does not have any starting standards, and the reimbursement rate is 60%.
Third, urban and rural residents health insurance reimbursement ratio (Hunan, for example)
Participating residents in the integrated area of basic medical insurance designated medical institutions hospitalization medical fees within the scope of the policy, the portion of the starting standard or above, by the urban and rural residents health insurance fund will be paid according to the proportion: township health centers, community health service institutions not less than 80%;
County medical institutions not less than 70%; municipal medical institutions, not less than 70%. less than 70%; and no less than 60% for municipal medical institutions. The coordinated areas reasonably determine the specific payment ratio according to the income and expenditure of the urban and rural residents' medical insurance fund.
Participating residents hospitalized in provincial fixed-point medical institutions, the starting standard in accordance with the previous year's provincial fixed-point medical institutions hospitalization average cost of about 10%, and not less than 1,500 yuan, hospitalization within the scope of the policy to pay no less than 50% of the medical fees,
Specific payment standards by the Provincial Department of Human Resources and Social Security, in conjunction with the Provincial Department of Finance in accordance with the coordinated areas of urban and rural residents' medical insurance fund operation and access to medical care. The specific payment standard will be determined by the provincial Human Resources and Social Security Department in conjunction with the provincial Finance Department according to the operation of the fund and the medical situation of the insured residents in each integrated area.
The urban and rural residents' medical insurance fund sets the maximum payment limit for hospitalization. Within a settlement year, the cumulative maximum payment limit for urban and rural residents' basic medical insurance (excluding urban and rural residents' major disease insurance) is unified at 150,000 yuan.
Expanded Information
Once a participant goes through the procedure of confirming his/her medical treatment in a foreign country, the participant can seek medical treatment in the designated medical institution of a foreign country. The individual medical account amount can be withdrawn from any business outlets with the medical insurance card, and used to support outpatient general illness costs and the cost of purchasing and dispensing medicines in pharmacies. Participants who are sick and hospitalized (including outpatient specific treatment) can go to the local designated medical institutions for hospitalization and outpatient specific treatment, and the medical expenses will be paid by the individual first, and then within 1 month from the date of discharge from the hospital, the participant will apply for reimbursement from the Municipal Medical Insurance Center by presenting the following information; 1. A copy of the front and back of the medical insurance card; 2. A confirmed copy of the "Out-of-town Medical Insurance for Medical Treatment". A copy of the confirmed "Application Form for Medical Care in a Different Place"; 3, a certificate of discharge or diagnosis, and a copy of the "Outpatient Special Application Form" approved by the Municipal Health Insurance Center for outpatient specific items (except for emergency observation); 4, a detailed list of medical expenses; 5, an official bill for medical expenses (with a reimbursement signature on the back); 1, certificate of unit; 2, proof of the insured person; 3, official receipt of medical expenses (with signature of the person behind it) Proof of unit; 2, a copy of the front and back of the medical insurance card; 3, a certificate of discharge or diagnosis; 4, a detailed list of medical expenses; 5, an invoice of the medical expenses (with the reimbursement of the person answering the name on the back); 6, a copy of the hospitalization medical records. Baidu Encyclopedia - Medical Insurance Reimbursement Rate