(a), outpatient reimbursement rate
On the basic health insurance for urban workers, if you are an active employee, to the hospital outpatient, emergency visit after the hospital, more than 2,000 yuan of medical expenses can be reimbursed, reimbursement rate is 50%. If you are a retiree under 70 years old, you can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70%. If the retiree is over 70 years old, expenses over $1,300 can be reimbursed the reimbursement rate is 80%. And no matter which category of people, the maximum limit of outpatient and emergency large medical expenses paid is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, the $500 portion can be reimbursed at 50%, which is $250.(II), hospitalization reimbursement rate
Currently the starting amount for the first time in a year when you use the basic medical insurance to pay, whether you are an active employee or a retired person, is 1300 yuan. For the second and subsequent hospitalizations, the starting amount is set at 50%, which is RMB 650. And the maximum payment from the Basic Medical Insurance Co-ordination Fund (for hospitalization expenses) in a year is currently 70,000 yuan.(Three), hospitalization starting standard
Tertiary hospitals: 700 yuan within a year for multiple hospitalizations starting 500 yuan, 400 yuan, 300 yuan employee health insurance reimbursement ratio of 2016. Second-level hospitals: 600 yuan within a year. The starting payment for multiple hospitalizations is 400 yuan, 300 yuan, 200 yuan. First-class hospitals including the following: 500 yuan within a year of multiple hospitalization starting payment in order of 300 yuan, 200 yuan, 100 yuan. Below the maximum payment limit above the starting line, Category A and general medical fees for active employees pay 85% Retirees pay:90%. Class B drugs pay 75% high precision pay 70%. Employee health insurance for chronic and special diseases, major diseases, the starting standard is 700 yuan during the year. Category A and general diagnosis and treatment pay 80%, category B is 75% highly sophisticated 70%.(four), the scope of reimbursement
medical expenses for outpatient and emergency treatment; the cost of medicines purchased at designated retail pharmacies; the medical costs of emergency rescue and hospitalization and income from hospitalization, the medical costs of their hospitalization before staying in hospital for 7 days; malignant tumors radiation therapy and Chemotherapy of malignant tumors, renal dialysis, outpatient medical expenses for taking anti-rejection drugs after renal transplantation. The following items are excluded from the reimbursement of urban workers' medical insurance: (1) Service items. (1) registration fees, out-of-hospital consultation fees, medical records cost; (2) consultation fees, examination and treatment of expedited fees, surcharges on named surgery, quality premiums, self-requested special nurses and other special medical services. (2) Non-disease treatment program category. (1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery, etc.; (2) a variety of weight loss, fat, height projects. (3) a variety of health checkups; (4) a variety of preventive, health care treatment programs; (5) a variety of medical consultations, medical appraisal. (3) diagnostic and treatment equipment and medical materials employee production, outpatient and inpatient medical expenses reimbursement ratio is different, and they have a starting standard, more than this standard, can be reimbursed for medical expenses. Not all medical items can be reimbursed, such as cosmetic items, physical examination, medical appraisal and other items of expenditure, medical insurance will not give reimbursement.