What's the reimbursement rate of newborn medical insurance hospitalization?

The reimbursement rate of neonatal hospitalization medical insurance varies from region to region. Taking Suzhou as an example, the medical expenses incurred by insured children in designated medical institutions in the settlement year.

Qifubiaozhun (500 yuan) shall be borne by the individual, and the part above Qifubiaozhun to 40,000 yuan (including 40,000 yuan) shall be paid by the medical insurance fund; 40,000 yuan to 654.38+ten thousand yuan (including 654.38+ten thousand yuan)

Pay 80%; 65438+ 90% of RMB 10,000 to RMB 200,000 (including RMB 200,000).

Cumulative medical expenses for hospitalization that meet the scope of basic medical insurance, the following part of Qifubiaozhun, and medical expenses that exceed Qifubiaozhun, are hospitalized in county-level and other designated medical institutions,

Urban and rural residents' medical insurance fund pays 80%; In the county level two and the corresponding designated medical institutions and three designated medical institutions hospitalization, urban and rural residents medical insurance fund to pay 70%; Hospitalization in designated medical institutions outside the county and in the city,

Urban and rural residents' medical insurance fund pays 50%; Hospitalization in designated medical institutions outside Wenzhou, urban and rural residents medical insurance fund to pay 40%.

The proportion of hospitalization reimbursement for neonatal jaundice is as follows:

1, the reimbursement rate of residents, 60% of town hospitals; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;

2. Social security refers to urban workers. The minimum threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

3. Reimbursement in different places needs to be reimbursed back to the hometown (insured place), and the reimbursement ratio is 35-65%.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. Establish a medical insurance fund through contributions from employers and individuals,

After the insured person has medical expenses, the medical insurance institution will give certain economic compensation.

To sum up, each province and city has different regulations on the reimbursement ratio of newborn medical insurance. At present, there is no uniform standard, and the reimbursement ratio of different levels of hospitals is different.

If the baby is sick and hospitalized, he can be reimbursed according to a certain proportion after handling the medical insurance card. The reimbursement rates of the first, second and third level hospitals are 80%, 70% and 60% respectively.

The maximum payment limit of the overall fund is 50,000 yuan, and the maximum payment limit of serious illness medical insurance reaches 654.38+10,000 yuan.

Legal basis:

People's Republic of China (PRC) social insurance law

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.