Huzhou urban residents basic medical insurance

Reimbursement rates for urban residents' medical insurance

I. Students and children (below 180,000 yuan)

1. 55% reimbursement rate for tertiary hospitals;

2. 60% reimbursement rate for secondary hospitals;

3. 65% reimbursement rate for primary hospitals.

II. Seniors over 70 years old (less than 100,000 yuan)

1. 50% reimbursement from tertiary hospitals;

2. 60% reimbursement from secondary hospitals;

3. 65% reimbursement from primary hospitals.

Third, other urban residents (less than 100,000 yuan)

1, 50% reimbursement rate for tertiary hospitals;

2, 55% reimbursement rate for secondary hospitals;

3, 60% reimbursement rate for primary hospitals.

Basic drug reimbursement rate of health insurance

1, a hospital reimbursement

1 hospital basic drug reimbursement rate of 20%;

2 not implemented basic drug reimbursement rate of 40%

2, a hospital reimbursement

basic drug reimbursement at 42%.

3, tertiary hospital reimbursement

Basic drugs are reimbursed at 55%.

Rates of reimbursement for outpatient services: there is no starting line for general outpatient services. All insured residents are entitled to general outpatient services. Within a medical insurance year, there is no starting line for general outpatient treatment, and medical expenses within the scope of the outpatient coordinating fund are reimbursed at a rate of 60%, with an annual individual maximum payment limit of 400 yuan for the coordinating fund.

Hospitalization reimbursement rate: the longer the continuous participation in the reimbursement rate the greater the insured residents continuous contributions for every five years, the medical insurance fund hospitalization reimbursement rate increased by 5 percentage points, the cumulative total of not more than 10 percentage points. If you have been insured for 10 consecutive years from 2007, then the reimbursement rate for hospitalization in third-level, second-level and first-level hospitals reaches 70%, 80% and 90% respectively.

Ratio of reimbursement for medical treatment in non-participating places: For second-tier contributions, hospitalization in second-tier and second-tier or lower designated medical institutions in non-participating places does not require referral for approval and reimbursement will be settled directly in the hospitals where the patients are hospitalized at the stipulated ratio.

First-tier contributions, with a referral certificate, can be reimbursed at the hospital at the out-of-town rate, without referral approval, you need to pay 10% of the medical expenses first.

Ratio of reimbursement for medical treatment in other places: the second class of payment, with a referral certificate to the designated designated hospitals in the province for hospitalization, after discharge from the hospital directly in the hospital reimbursement to enjoy the provincial hospitalization reimbursement policy, the individual does not need to advance hospitalization costs. The first class contribution, after discharge from the hospital, the individual full advance hospitalization costs, with the referral certificate back to the local referral hospital for reimbursement

Second reimbursement ratio

"Second reimbursement" may be "reimbursed again" in the insured residents of a single hospitalization occurs In a single hospitalization of the insured residents, the part of the medical expenses that are within the scope of the urban residents' basic medical insurance co-ordination fund, after the basic medical insurance co-ordination fund pays in proportion to the individual's burden of more than 8,000 yuan, the funds of the major disease insurance for the excess part of the "secondary reimbursement" at a rate of 55%.

The medical expenses incurred by an insured resident who has been hospitalized several times in a year, after the payment of basic medical insurance and "secondary reimbursement", the part of the hospitalized medical expenses (including compliant and reasonable out-of-pocket expenses) borne by an individual in a year exceeding 25,000 yuan shall be reimbursed to him/her again by the funds of the major disease insurance at the rate of 55% of the excess part. "reimbursement", the annual individual maximum payment limit of 250,000 yuan from the major disease insurance funds.

Reimbursement rate for outpatient chronic diseases

1. There is no ceiling line for Category A outpatient chronic diseases, and the reimbursement rate is 60%;

2. The reimbursement rate for Category B outpatient chronic diseases is 50%.

Warm tips:

1. Students and minor residents, special groups of people will pay the fee according to the first class and enjoy the second class.

2. Special groups of people are orphans, rural five guarantees for the maintenance of objects, urban and rural "three have-nots", urban and rural minimum subsistence guarantee objects, enjoying the regular quantitative relief of the 60's old workers retired from the reduction, the severely disabled.

Expanded Information:

Medical insurance for urban residents is a medical insurance system for urban minors and unemployed residents who do not have medical insurance for urban workers.

It is a major initiative of the CPC Central Committee and the State Council to further solve the problem of medical insurance for the general public and continuously improve the medical insurance system following the implementation of the basic medical insurance system for urban workers and the new rural cooperative medical system.

It is mainly a systematic arrangement for the medical insurance of urban non-working residents.

The emergence of this system was of great significance in the course of China's social insurance system reform, and pointed out the direction of China's social insurance system reform.

China began to establish a basic medical insurance system for urban workers in 1998, and in order to realize the goal of basically establishing a medical insurance system covering all urban and rural residents, the State Council decided to carry out a pilot project of basic medical insurance for urban residents from 2007.

On January 12, 2016, the State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, which called for advancing the integration of the urban residents' medical insurance and the New Rural Cooperative Medical Insurance systems, and gradually setting up a unified medical insurance system for urban and rural residents nationwide.

Differences with employee health insurance

One is the difference in the population. The urban workers' health insurance is mainly for working employees and retirees who have a work unit or are engaged in the self-employed economy. The urban residents' health insurance is mainly for unemployed elderly residents with urban household registration, low-income recipients, persons with severe disabilities, students and children, and other urban non-employees;

The second is the difference in the standard of contribution and its source. Urban workers' health insurance is paid by employers and individual workers***, and is not subsidized by the government. The urban residents' health insurance contribution standard is generally lower than that of the employees' health insurance, and the government gives appropriate subsidies on the basis of individual contributions;

Thirdly, the treatment standards are different. Urban residents' health insurance due to the lower level of financing, medical treatment standards are generally slightly lower than the employee health insurance.

Fourth, the contribution requirements are different. Urban workers' medical insurance set up a minimum contribution period, to meet the contribution period (25 years for men, 20 years for women), after retirement, no longer contribute to enjoy the basic medical insurance benefits; urban residents' medical insurance does not set up a minimum contribution period, must be paid every year, do not pay no treatment.

Reference:

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