Suzhou employee medical insurance reimbursement ratio 2023

2023Suzhou employee medical insurance reimbursement ratio has the following two situations:

Medical insurance reimbursement ratio is determined according to local policies and regulations, and the reimbursement ratio may vary in different areas. 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, generally ranging from 70% to 80%;

2. Individual out-of-pocket payment ratio: the individual out-of-pocket payment ratio refers to the proportion of medical expenses that the individual needs to bear, generally ranging from 20% to 30%.

Medicare reimbursement standard:

1, residents reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%;

2, urban residents, in a billing year, incurred in line with the scope of reimbursement of the medical expenses of less than 100,000 yuan, tertiary hospitals, the starting standard of 659 yuan, reimbursement rate of 50% upper limit is 2,000 yuan; the starting standard for hospitalization in second-level hospitals is 300 yuan, with a reimbursement rate of 55%; first-level hospitals do not have a starting standard, with a reimbursement rate of 60%;

3. If the reimbursement is made in a different place, the reimbursement needs to go back to the place where the old family participates in the insurance, and the reimbursement rate is between 35-65%, and the rate varies according to the level of the hospitals.

Medical insurance reimbursement process:

1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their treatment items belong to the scope of reimbursement of medical insurance;

2, collection of reimbursement materials: collection of the relevant records of treatment, drug receipts, medical cost lists and other related materials;

3, to the social security department to handle the reimbursement: submit the relevant materials to the local social security department to handle the reimbursement.

4. Waiting for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receiving the reimbursement payment: after the audit is approved, you can receive the reimbursement payment of the medical insurance at the designated bank.

In summary, the reimbursement rate of medical insurance is different in each region, urban and rural residents living in a different place for a long period of time, urban and rural residents aged 60 years old and 55 years old, urban and rural residents and urban and rural residents working in a different place, and students and children living with them, have applied for the record of registration of medical treatment in a different place, and in the place of registration and record of medical treatment in the hospitalization of the threshold standard for the first level of hospitals 400 yuan, the second level of 800 yuan, the third level of 2000 yuan, the reimbursement rate of execution of the reimbursement rate. The reimbursement rate shall be the same as the reimbursement rate of local designated hospitals.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical services and facilities, as well as those for emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.