As far as I know, the current reimbursement method of Wujiang City Basic Medical Insurance for hospitalization is as follows:
(If my understanding is not in line with the policy, the policy shall prevail)
(1) For active participants:
Firstly, deduct the out-of-pocket expenses for the items, such as the portion of the bed charge above the limit,
Secondly, the proportion of certain medicines or examination and treatment items to be paid by the individual first is deducted, ranging from 5% to 20%;
Again, the 400 yuan threshold is also deducted;
The remaining expenses are included in the reimbursement scope of the reimbursement of 84%.
That is, in addition to the three parts that are not good for reimbursement, the part that is good to include in the reimbursement is reimbursed 84 percent.
The flip side of this is that what you pay out of pocket consists of 4 parts: out-of-pocket expenses + the proportional out-of-pocket portion + the $400 starting band + 16% of the remaining amount.
(ii) General retired participants:
Change the 84% reimbursement above to 92% reimbursement. That is:
First, deduct the out-of-pocket expenses, such as the portion above the limit of bed charges, companion beds, blood charges, albumin, and other out-of-pocket expenses or medicines;
Secondly, deduct the proportion of certain medicines or checkups or treatments to be paid by the individual upfront, which varies from 5% to 20%;
Once again, deduct the 400 yuan starting payment section;
Remaining expenses is reimbursed 92 percent under reimbursement.
That is, in addition to the three portions that are not good for reimbursement, the portion that is good to include in reimbursement is reimbursed 92%.
This way what you pay out of pocket also includes 4 parts: out-of-pocket expenses + the proportional out-of-pocket portion + the $400 starting band + 8% of the remaining amount.
Additionally:
1. For the second hospitalization or more than the second hospitalization within the health insurance year, the starting band is reduced to $300.
2. For chemotherapy patients hospitalized for treatment, the starting payment band is abolished, and the relevant chemotherapy drugs are reimbursed at a preferential rate without computerized card settlement. Patients can apply for reimbursement by filling in the application form in the medical insurance department and then reimbursement and settlement can be made directly to the medical insurance department with the discharge receipt, list and discharge record after discharge from the hospital.
3, treatment in foreign hospitals must first apply for transfer procedures, by the local hospital (Wujiang Hospital) issued a transfer certificate, and in Wujiang City, the medical insurance department stamped permission before the transfer of hospital treatment. After being discharged from the hospital, you will be reimbursed and settled directly with the medical insurance department with the discharge receipt, list and discharge record.
4, in the course of treatment involving large amounts of material appliances such as artificial joints, pacemakers, transplants, etc. must first fill out an application form to the municipal health insurance department.
5, the health insurance provisions of the uninsured diseases or events shall not be included in the scope of reimbursement of health insurance, see "cooperative medical reimbursement rate" post.