Proportion of reimbursement in Zhanjiang 3A hospitals

Proportion of reimbursement in Zhanjiang 3A hospitals:

1. Reimbursement ratio: Medical insurance policies usually stipulate that tertiary hospitals have a higher reimbursement ratio, which can reach more than 80%. This means that medical insurance can reimburse you for part of the expenses incurred in the outpatient department of a third-class first-class hospital;

2. Limit the scope of diseases: The medical insurance policy may stipulate that only certain diseases or operations are treated in tertiary hospitals to enjoy a higher reimbursement rate. Other diseases can be executed at a lower reimbursement rate;

3. Partial reimbursement at one's own expense: The medical insurance policy may stipulate that some items or drugs need to be reimbursed at one's own expense, which is not within the scope of reimbursement.

New national medical insurance reimbursement policy;

1, outpatient reimbursement

If the hospital sees a doctor with minor ailments and pains, it will usually generate more outpatient expenses. Then the employee's medical insurance can directly deduct the outpatient expenses from his personal account balance, while the outpatient expenses accumulated by the resident's medical insurance in 200 yuan this year can be reimbursed according to the proportion of 50%, and the maximum payment limit is 400 yuan.

2, hospitalization reimbursement

There are new changes in the ups and downs of hospitalization this year, which are defined as a primary doctor in 200 yuan, a secondary hospital in 400 yuan and a tertiary hospital in 800 yuan. If the hospitalization expenses of the insured are above the deductible line, the reimbursement rate of employees' medical insurance can be divided into 88%, 85% and 82% according to the level of these hospitals, while the reimbursement rate of residents' medical insurance is 80%, 70% and 60% respectively, and the deductible line standard for more than two hospitalizations in the same natural year is 50% of the first deductible line standard.

3, reimbursement conditions

The standard reimbursement conditions specified this year do not include the following five medical expenses:

(1) Seek medical treatment abroad, Hong Kong, Macao and Taiwan;

(2) Suicide or self-mutilation (except mental illness);

(3) Accidents such as traffic, accidental injury and medical treatment are borne by other parties;

(4) Being injured or sick due to his own illegal and criminal acts;

(5) Other expenses that are not paid by medical insurance regulations, such as cosmetic surgery, weight loss, infertility, sexual dysfunction, etc.

The latest policy of employee medical insurance:

1, outpatient reimbursement ratio

After getting medical insurance, if you are an on-the-job employee, you can only reimburse more than 2,000 yuan for medical expenses in the emergency department of the hospital, and the reimbursement rate is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, expenses above 1300 yuan can be reimbursed, accounting for 80%. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan.

For example, if an on-the-job worker spends 2,500 yuan in outpatient service, then 500 yuan can reimburse 50%, that is, 250 yuan.

2. Proportion of hospitalization reimbursement

At present, when the basic medical insurance is first used within one year, the minimum payment for employees and retirees is 1300 yuan. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

To sum up, after the reform of employee medical insurance, it is obvious that the money in personal accounts has decreased, but they can enjoy outpatient reimbursement, so in essence, those individuals who often see a doctor have not reduced their medical insurance benefits. Of course, there is actually an upper limit for outpatient reimbursement, and the regulations in each region are different.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.