Reimbursement ratio of top three hospitals in Zhengzhou employee medical insurance

The tertiary hospital is a tertiary first-class hospital, which can be said to be the highest level hospital in Chinese mainland. Of course, the medical level is very good. It costs a lot of money to go there to see a doctor, but it can also be reimbursed.

First, what is the Third Hospital?

A third-class first-class hospital (referred to as "third-class hospital" for short) is the level of medical institutions classified according to the current Measures for the Administration of Hospital Classification in China, and it is the highest level among the "third-class and sixth-class" hospitals in mainland China.

The main items of application and evaluation of 3A hospitals include medical service and management, medical quality and safety, technical level and efficiency. Private hospitals in Chinese mainland can also participate in medical grading.

Grade III (the number of beds is more than 50 1) is a hospital above the regional level that provides high-level medical and health services and carries out higher education and scientific research tasks in the local area and surrounding radiation areas. According to the scoring standard, a grade is obtained, and more than 900 points are designated as a grade.

Proportion of medical insurance reimbursement "/"

2. What's the latest reimbursement rate for medical insurance in 3A hospitals?

1, deductible line

The deductible line, that is, the initial amount of reimbursement, can only be applied for reimbursement if it reaches the deductible line. Different hospitals have different hospitalization reimbursement deductible lines, and the reimbursement deductible lines of 3A hospitals are within 800 yuan.

2. Proportion of reimbursement

The higher the hospital level, the more reimbursement sections and the lower the reimbursement ratio. The reimbursement ratio of 3A hospitals is as follows:

(1) 80% of the deductible line from 800 yuan to 5,000 yuan;

(2) 85% will be reimbursed from 5000 yuan to 10000 yuan;

(3) 90% of the part above the maximum payment limit 10000 yuan;

(4) Retirees will be increased by 5% on the basis of the above reimbursement ratio.

3. What is the reimbursement scope of hospitalization medical insurance?

Reimbursement scope:

Medical expenses: auxiliary examination: the examination expenses of electrocardiogram, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and MRI are limited to 200 yuan;

Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

Legal objectivity:

Article 28 of the Social Insurance Law conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid by the basic medical insurance fund in accordance with state regulations. Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.