A, door (emergency) diagnosis of large Medicaid maximum payment limit of 5500 yuan; Qifubiaozhun is 800 yuan, an on-the-job employee, 700 yuan, a retiree over 60 and under 70, and 600 yuan, a retiree over 70. Reimbursement ratio: the reimbursement ratio of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 65%; The reimbursement rate of first-class hospitals is 75%. Two, hospitalized in a medical year, the first hospitalization Qifubiaozhun, tertiary hospital 1700 yuan, secondary hospital 1 100 yuan, a hospital in 800 yuan. Secondary and above hospitalization: tertiary hospital 500 yuan, secondary hospital 350 yuan, and primary hospital 270 yuan. The reimbursement rate for employees whose Qifubiaozhun is more than 55,000 yuan is 85%; Retirees are 90%. For medical expenses ranging from 55,000 yuan to 6,543.8+0.5 million yuan, the reimbursement ratio of employees and retirees is 80%. Old workers who took part in the work before the founding of the People's Republic of China were reimbursed 95% in tertiary and secondary hospitals and 97% in primary hospitals.
legal ground
Thirtieth "People's Republic of China (PRC) Social Insurance Law" full text of the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.