What is the reimbursement rate of medical insurance in different places in Guangdong?

What is the reimbursement rate of medical insurance in different places in Guangdong?

The proportion of medical insurance reimbursement in different places in Guangdong is generally as follows:

Proportion of reimbursement for medical insurance hospitalization in different places:

Policy of the insured place-deductible line 1 10,000 yuan-capping line 1 10,000 yuan-reimbursement ratio 50%- annual maximum payment limit (different hospitals at different levels in different cities determine the payment ratio according to the situation, and the payment ratio of retirees can be increased by 5% compared with that of on-the-job personnel).

The medical expenses above the deductible line and below the capping line shall be borne by the individual first, among which, the part of the compliance medical expenses borne by the individual that exceeds the deductible line standard shall be reimbursed by the medical insurance fund in proportion.

The medical insurance fund is reimbursed according to the "three-stage" policy, as follows: (1) deductible line to capping line, and hospitalization is reimbursed by stages. Among them, 90% of the expenses between the deductible line and the capping line are paid by designated medical institutions at the first level and below, 85% by designated medical institutions at the second level, 80% by designated medical institutions at the third level, and the retirees are increased by 5 percentage points respectively. (2) The part above the top line is not included in the scope of medical insurance reimbursement.

The insured person of medical insurance in different places shall go through the referral and filing procedures in accordance with the regulations and go to the designated medical institutions outside the city for hospitalization, and the hospitalization expenses shall be paid according to the single disease. Medical insurance in different places without referral and filing procedures shall be included in the payment scope of the overall fund according to 50% of the hospitalization expenses at that time.

Proportion of reimbursement for outpatient medical insurance in different places:

Policy of the insured place-deductible line 500 yuan-annual maximum compensation limit (different hospitals in different cities and levels shall determine the proportion of compensation as appropriate).

The insured person shall go through the referral and filing procedures in accordance with the regulations, and the outpatient medical expenses incurred by the designated medical institutions outside the city shall be included in the payment scope of the overall fund according to 50% of the current medical expenses.

To sum up, the reimbursement rate of medical insurance in different places in Guangdong varies according to the policy of the insured place, the deductible line, the capping line, the hospital and the situation. Generally speaking, the proportion of hospitalization reimbursement is high, and the proportion of outpatient reimbursement is low. At the same time, you can enjoy better medical insurance benefits in different places by handling referral and filing procedures. For the latest details, it is recommended to consult the local social security bureau or relevant institutions for specific off-site medical insurance policies and reimbursement rates.

Legal basis:

Article 29 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "The medical expenses incurred by the insured shall be paid by the basic medical insurance fund and directly settled by social insurance agencies, medical institutions and pharmaceutical business units."

The Administrative Measures for Medical Treatment in Different Places of Basic Medical Insurance in Guangdong Province stipulates: "The insured person shall go through the referral and filing procedures in accordance with the regulations, and be hospitalized in a designated medical institution outside the city, and the hospitalization expenses shall be paid according to the single disease. The hospitalization expenses of medical insurance participants in different places who did not go through the referral and filing procedures were included in the scope of payment of the overall fund according to 50% of the hospitalization expenses at that time. "