Provisions of Shaoxing Municipality on reimbursement for outpatient service of special diseases

In 2022, the reimbursement scope of Shaoxing social security medical insurance, the reimbursement ratio of Shaoxing social security medical insurance, and how much can Shaoxing social security medical insurance reimburse!

First, the reimbursement scope of Shaoxing social security medical insurance in 2022

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

(1) paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It should be borne by public health;

(4) Go abroad for medical treatment.

Two, Shaoxing city social security medical insurance urban workers hospitalization medical expenses reimbursement ratio:

Qifubiaozhun: 800 yuan, a tertiary medical institution, 600 yuan, a secondary medical institution, other medical institutions and 400 yuan, a township (street) community health service center, hospital and service station under its jurisdiction.

Qifubiaozhun for the number of hospitalizations: For the second hospitalization in the same medical insurance year, the second Qifubiaozhun is calculated at 50% of the hospitalization Qifubiaozhun, and the Qifubiaozhun will not be calculated after the third hospitalization; Reimbursement ratio: within one medical insurance year, the expenses within the policy scope of hospitalization and special disease outpatient service of the insured at the same level in Shaoxing:

1, the minimum threshold is 50,000 yuan:

(1), in primary medical and health institutions, employees are reimbursed 85% and retirees are reimbursed 90%;

(2) For medical treatment in other medical institutions, 80% of employees are reimbursed and 85% of retirees are reimbursed;

2. 50,000 yuan to 654.38+10,000 yuan:

(1), in primary medical and health institutions, 90% of employees are reimbursed and 95% of retirees are reimbursed.

(2) In other medical institutions, 85% of employees are reimbursed and 90% of retirees are reimbursed;

3, 65438+ 10,000 yuan to the maximum payment limit:

On-the-job employees are reimbursed 90%, and retirees are reimbursed 95%.

Note: In a medical insurance year, the cumulative maximum payment limit for hospitalization and special disease outpatient service is now 240,000 yuan. Outpatient medical expenses reimbursement: Qifubiaozhun: 400 yuan; Reimbursement ratio: within one medical insurance year, the expenses incurred by the insured in Shaoxing urban area in the general outpatient service of designated medical institutions within the policy scope:

Qifubiaozhun is above 400 yuan, and the maximum payment limit is below 5,000 yuan. In primary medical and health institutions, 70% of employees are reimbursed and 80% of retirees are reimbursed; In other designated medical institutions, employees are reimbursed 60% and retirees 70%. Scope of reimbursement for hospitalization medical expenses of urban and rural residents:

Qifubiaozhun: tertiary medical institution 800 yuan, secondary medical institution 600 yuan, other medical institutions and primary medical and health institutions 400 yuan. Qifubiaozhun for special disease outpatient service is 400 yuan.

Qifubiaozhun for the number of hospitalizations: For those hospitalized many times in the same medical insurance year, the second Qifubiaozhun is calculated as 50% of the hospitalization Qifubiaozhun, and the Qifubiaozhun will not be calculated after the third hospitalization. Reimbursement ratio: (1) 80% for adults in primary medical and health institutions and 75% for adults in other designated medical institutions;

(II) For the part where the minimum threshold for minors (students) is more than 60,000 yuan, 85% will be reimbursed for medical treatment in primary medical and health institutions and 80% will be reimbursed for medical treatment in other designated medical institutions; 60,000-200,000 yuan, 95% of medical expenses are reimbursed in primary medical and health institutions, and 90% are reimbursed in other designated medical institutions. Outpatient medical expenses reimbursement: within a medical insurance year, the insured will be reimbursed 30% within the scope of the general outpatient medical treatment policy of primary medical and health institutions, including 45% for Chinese herbal pieces and Chinese medical treatment items.

Three, Shaoxing social security medical insurance reimbursement address

Shaoxing social insurance enterprise management bureau

Address: No.2 Tiejiaying, Shaoxing

Tel: 0575-88907 148

Shaoxing county society insurance enterprise management bureau

Address: No.23 Jianhu Road, Ke Qiao, Shaoxing County

Tel: 0575-84787 176

Xinchang county society insurance enterprise management bureau

Address: No.0/79, Gushan Road, Xinchang County, Shaoxing

Tel: 0575-862400 17

Zhuji society insurance enterprise management bureau

Address: No.58 Jidong Road, Zhuji, Shaoxing

Tel: 0575-87 1 13763

Shangyu society insurance enterprise management center

Address: No.8, Minzhongxin Road 1, Shangyu District, Shaoxing

Tel: 0575-82 188599

(1). How to handle Shaoxing's serious illness medical insurance and how to register the reimbursement ratio of Shaoxing's serious illness medical insurance 202 1 (2). How to reimburse Shaoxing residents' medical insurance 202 1 and what is the reimbursement ratio (3). How to handle medical insurance for serious illness in Shaoxing 202 1 How to declare reimbursement for serious illness in Shaoxing (IV) 100000000005 Online activation process of Shaoxing social security card (V). How to pay online for medical insurance in Shaoxing 202 1, online payment platform for medical insurance for residents in Shaoxing (6). The latest policy statement 202 1 (7) on reimbursement scope and reimbursement ratio of Shaoxing medical insurance for serious illness. Shaoxing Newborn Medical Insurance 202 1 (8) Handling Process and Reimbursement Ratio Description. Description of the proportion process and quota of Shaoxing urban and rural medical insurance reimbursement in 2020 (9). Relief Policy for Serious Illness of Retired Workers in 2020; Relief Policy for Coverage of Serious Illness Medical Insurance in Shaoxing (IX)

Shengzhou society insurance enterprise management bureau

Address: No.369 Shancheng Road, Shengzhou, Shaoxing

Tel: 0575-83 184393