Proportion of medical insurance reimbursement in Shantou First Affiliated Hospital

Shantou First Affiliated Hospital medical insurance reimbursement ratio standard is as follows:

1. The proportion of medical insurance reimbursement for employees is divided according to the actual medical expenses incurred by the insured. Usually, the lowest reimbursement rate for hospitalization is 85%, and the highest reimbursement rate is 95%; The proportion of medical insurance reimbursement for urban and rural residents is between 50% and 80% according to the hospital level. Due to the different economic levels in different regions, the proportion of medical reimbursement may be slightly different. "

2, medical insurance card reimbursement is generally proportional, generally 60%-70%. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The minimum threshold of tertiary hospitals is 659 yuan, and the upper limit of reimbursement ratio is 2000 yuan. The minimum threshold for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%. There is no minimum threshold for first-class hospitals.

The reimbursement rate of medical insurance is as follows:

The proportion of medical insurance reimbursement is determined according to local policies and regulations, and there may be differences in the proportion of reimbursement in different regions. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%;

2. Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, the proportion of medical insurance reimbursement in different regions is different. Urban and rural residents living in different places for a long time, urban and rural residents over 60 years of age and women over 55 years of age, urban and rural residents working in different places and their accompanying children have registered for medical treatment in different places. The deductible standards for hospitalization in the registered places are 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan respectively, and the reimbursement ratio is implemented by local designated hospitals.

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.