How much is the reimbursement for residents' medical insurance?

The proportion of residents' medical insurance reimbursement varies with different groups of people and different hospital levels.

These include:

I. Students and children (less than 6.5438+0.8 million yuan):

The reimbursement rate of tertiary hospitals is 55%;

The reimbursement rate of secondary hospitals is 60%;

The reimbursement rate of first-class hospitals is 65%.

Two, the elderly over 70 years old (654.38+ ten thousand yuan):

The reimbursement rate of tertiary hospitals is 50%;

The reimbursement rate of secondary hospitals is 60%;

The reimbursement rate of first-class hospitals is 65%.

III. Other urban residents (6,543,800 yuan+10,000 yuan):

The reimbursement rate of tertiary hospitals is 50%;

The reimbursement rate of secondary hospitals is 55%;

The reimbursement rate of first-class hospitals is 60%.

Outpatient reimbursement

1. Overall reimbursement for general outpatient service. The general outpatient service is limited to the designated medical institutions at or below the county level in the insured area (the floating population in different places can visit the designated medical institutions at the county level, township hospitals and community health service centers in the place where they move in) and enjoy the overall reimbursement treatment for the general outpatient service. County-level designated medical institutions shall be reimbursed 50%, and township (town) hospitals (including community health service centers) and village clinics shall be reimbursed 70%. There is no deductible, and each person is capped in 600 yuan every year.

2. Outpatient reimbursement for chronic diseases. Rheumatoid arthritis (RA), arthropathy (hip and knee), psychosis, cerebrovascular disease and its sequelae (accompanied by severe dysfunction), hypertension (stage II and III), diabetes (accompanied by one of the complications of cardiovascular, cerebral, renal or peripheral vascular diseases), chronic obstructive emphysema, pulmonary heart disease, active tuberculosis, rheumatic heart disease, senile dementia, cardiomyopathy, asthma, nephrotic syndrome, etc. Pneumoconiosis, heart disease complicated with cardiac insufficiency, coronary heart disease, systemic lupus erythematosus, nervous system tumor, lymphoma, liver cancer, leukemia (except for standardized drug treatment of chronic myeloid leukemia), aplastic anemia, chronic cytopenia, hypothyroidism, Parkinson's disease, myasthenia gravis, gout, radiotherapy for malignant tumor (except for major diseases), chemotherapy for malignant tumor (except for major diseases), Medical expenses (excluding examination fees) incurred by 37 kinds of chronic diseases, such as interventional therapy for cardiovascular diseases and organ transplant anti-rejection therapy one year later, in selected public designated medical institutions or designated medical institutions above the third level, are reimbursed 60% without deductible, and the annual capping line is 20,000 yuan.

3. Outpatient reimbursement for major diseases. 0- 18-year-old children with congenital heart disease, leukemia, breast cancer, cervical cancer, end-stage renal disease, severe psychosis, multidrug-resistant tuberculosis, AIDS opportunistic infection, lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction, cerebral infarction, hemophilia A, hemophilia B and type I diabetes. The outpatient medical expenses of 25 major diseases (hereinafter referred to as 25 major diseases) such as children's congenital hypospadias and children's phenylketonuria in designated medical institutions in the province are paid according to the general hospitalization policy of designated medical institutions at that time, and there is no deductible. The capping line is calculated within the annual hospitalization capping line. Among them, outpatient dialysis treatment for end-stage renal disease, standardized radiotherapy and chemotherapy for breast cancer, cervical cancer, lung cancer, esophageal cancer, gastric cancer, colon cancer and rectal cancer in the agreed period, and major diseases such as multidrug-resistant tuberculosis, severe psychosis, chronic myeloid leukemia, hemophilia A, hemophilia B, hyperthyroidism, type I diabetes, acute myocardial infarction, etc. 15 are implemented according to the provincial major disease policy standards, which are at the national level 2 and above. If the designated medical institutions for major diseases outside the state fail to implement one-stop instant reporting, the insured individuals will return to the insured place to apply for reimbursement with the disease certificate and outpatient invoice; There is no deductible line and capping line, and the reimbursement rate is 80%.

Second, the general hospitalization reimbursement

1. Within the overall planning area (within the state). 90% reimbursement for township hospitals (including community health service centers); 80% reimbursement of county-level designated medical institutions; National designated medical institutions for referral reimbursement 65%, non referral reimbursement 30%;

2. Outside the overall planning area (out of state). Cross-city and inter-provincial designated medical institutions refer (record) 60%, and do not refer (record) 30%; Designated medical institutions in different places refer (record) 55%, and do not refer (record) 30%.

Residents' medical insurance refers to the medical insurance system that mainly covers urban minors and unemployed residents who have not participated in the medical insurance for urban employees. Mainly to make institutional arrangements for medical insurance for urban non-employed residents.

Legal basis:

Article 16 of the Announcement of the State Medical Security Bureau on Public Solicitation of Opinions on the Medical Security Law

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(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) Going abroad for medical treatment;

(five) physical fitness, health care consumption, health examination;

(six) other expenses that are not paid by the basic medical insurance fund stipulated by the state.

When it has a significant impact on economic and social development, the non-payment scope of the basic medical insurance fund can be temporarily adjusted through legal procedures.

Article 17

The expenses incurred by the insured of the basic medical insurance in the designated medical institutions that meet the payment scope of the basic medical insurance shall be paid by the basic medical insurance fund in accordance with the provisions.