What is the reimbursement rate of Fuzhou medical insurance?

Many of us are not very clear about the problems mentioned in the topic, and we don't understand them thoroughly, but they are closely related to our lives, so it is necessary to understand them. Today, I sorted out the relevant knowledge. Let's take a look. Reimbursement ratio of urban residents and college students: (1) The reimbursement ratio of general outpatient compensation treatment is 50%: the annual maximum payment limit (400 yuan/person calculated according to the actual reimbursement amount) Note: the annual maximum payment limit of college students (including the minimum payment standard and proportional out-of-pocket expenses): 2,000 yuan/person (2) The reimbursement ratio of outpatient compensation treatment for special diseases is 60%. And the outpatient expenses for serious diseases are less than 60,000 yuan (including more than 60,000 yuan to 6,543.8+0.4 million yuan (including 40% of the reimbursement rate of 6,543.8+0.4 million yuan) (3) The basic expenses for hospitalization compensation treatment in medical insurance coverage are less than or equal to 60,000 yuan (the reimbursement rate is 55% to 90%). 60,000 yuan for hospitalization and gradually reduce the reimbursement rate of 655 employees: the medical expenses incurred by the insured in the general outpatient service of designated medical institutions in medical insurance coverage during the year shall be paid according to the following standards: deductible line 1500 yuan and below: paid by personal account, and paid in cash when the personal account is insufficient. 65,438+0, 500 yuan to 6,000 yuan (inclusive): 60%-65% for on-the-job employees, and 70%-75% for retired employees. The insured employees use national essential drugs in designated community health service centers and township hospitals, and the deductible line is cancelled, which will be directly paid by the overall fund according to the prescribed proportion. The deductible line and capping line of medical insurance for special diseases and treatment items in workers' outpatient service (1): 800 yuan, and the highest payment limit of the co-ordination fund in that year was 1.2 million yuan. As a whole, the fund's first hospitalization deductible standard: the first hospitalization deductible line for tertiary designated medical institutions is 800 yuan for secondary and below designated medical institutions, and the first hospitalization deductible line for 600 yuan (including community health service centers and township hospitals 300 yuan). Many hospitalizations during the year: 200 yuan was reduced every time until it was reduced to zero (2). The overall fund pays 85%-90% of the outpatient special diseases and treatment expenses of the insured, and 90%-94% of the outpatient special diseases and treatment expenses of the retirees. Hospitalization medical expenses of retirees (3) Supplementary insurance for large medical expenses of employees: 65,438 yuan +0.2 million yuan. The cash reimbursement business of urban medical insurance is managed by the insured place, and the urban medical insurance department of each branch of the municipal social insurance fund management is responsible for it. The reimbursement condition is 1, and the applicant has gone through the insurance formalities and paid the medical insurance premium in full; 2, the cooperative medical system designated medical institutions for medical treatment; 3. The medical expenses incurred by the insured in hospitalization in medical institutions shall be paid in cash in advance, and relevant documents and materials shall be kept. Processing materials 1, original charge receipt; 2. Detailed list of expenses; 3. Outpatient medical records; 4. Proof of disease diagnosis; 5. Social security card; 6. Identity card; 7. Bank account. The processing flow of the application materials submitted by the applicant. Location: Medical Insurance Section of each social security branch of the Social Insurance Fund Administration in the insured area. The Social Insurance Fund Administration accepts the application 1, and the accepting department shall review the application materials within 5 days from the date of receiving the application materials and decide whether to accept them. 2. If the application materials are incomplete, the applicant shall be informed of all the contents that need to be corrected at one time within the above five days. 3. The applicant shall, within 5 days from the date of receiving the Notice of Supplementary Materials. 4, overdue correction, as the withdrawal of the application. 5. However, after the materials are corrected, the applicant may reapply within the legal validity period. After the application is completed and approved by the Social Insurance Fund Administration, the applicant will be reimbursed after receiving the Social Medical Insurance Medical Expense Reimbursement Form. The standard of reimbursement ratio, the deductible line of basic medical insurance for urban residents and the reimbursement ratio are determined according to the categories of insured persons. 1, students and children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%. They are old people in their seventies. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%. 3. Other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%. Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.