Interpretation of the new policy of Qingdao medical insurance reimbursement process and reimbursement ratio in 2023

Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. In this paper, please introduce the related knowledge of Qingdao medical insurance reimbursement. It mainly includes Qingdao medical insurance reimbursement process, Qingdao medical insurance reimbursement ratio and Qingdao medical insurance reimbursement policy.

I. Qingdao Medical Insurance Reimbursement Process and Required Materials The scope of residents' medical insurance reimbursement:

1. Medical expenses for serious illness hospitalization and serious illness outpatient service;

2. General outpatient medical expenses for the elderly;

3. Outpatient medical expenses for accidental injuries of children and college students;

4 in accordance with the provisions of the drug procurement costs;

5. Hospitalization expenses that meet the requirements.

The scope of reimbursement of urban workers' medical insurance pooling fund:

1. Hospitalization expenses incurred by the insured;

2. The treatment fee for outpatient treatment of special diseases of the insured;

3. Use the drugs, diagnosis and treatment items and facilities specified in the "Three Catalogues", and meet the medical expenses specified in the limited payment scope.

Reimbursement scope of individual accounts of urban workers:

1. Designated pharmacies buy retail drugs;

2. General outpatient medical expenses and hospitalization medical expenses are borne by the individual.

The cancellation condition is 1. The insured who has participated in the social medical insurance for residents in our city will enjoy the personal account treatment of basic medical insurance and the social medical insurance treatment for indigenous residents within 6 months of continuous payment;

2. After 6 months of continuous payment, employees are entitled to social medical insurance benefits according to regulations.

Original reimbursement materials 1, ID card or social security card;

2. Original disease diagnosis certificate issued by tertiary or secondary hospitals of designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If acting as an agent, provide the original ID card of the agent.

Two, Qingdao urban residents medical insurance reimbursement ratio and related policy reimbursement ratio

Qifubiaozhun

1. First-level hospital 200 yuan, second-level hospital 500 yuan, third-level hospital 800 yuan.

2. Full payment for the first hospitalization, half payment for the second hospitalization, and 100 yuan for the third and above hospitalization.

3 insured outpatient treatment of serious illness, a Qifubiaozhun burden once in a year.

Reimbursement ratio:

Medical expenses above Qifubiaozhun within the scope of overall payment,

The proportion of adult residents paying the first-class expenses is 85% in first-class hospitals, 80% in second-class hospitals and 70% in third-class hospitals.

80% of adult residents who pay for the second class are first-class hospitals, 70% are second-class hospitals and 55% are third-class hospitals.

90% of students and children are in first-class hospitals, 85% in second-class hospitals and 80% in third-class hospitals.

Note: Adult residents are hospitalized in street and town health centers (community health service centers) where the basic drug system is implemented, and the payment ratio is increased by 5 percentage points.

General outpatient service

Proportion: residents will be reimbursed 50% for the first file, and the highest annual reimbursement will be 720 yuan; 40% for residents' second grade and children, and the highest annual reimbursement for 300 yuan; 70% reimbursement for college students

Reimbursement of serious illness expenses for urban residents

Urban workers

Qifubiaozhun

1. First-level hospital 200 yuan, second-level hospital 500 yuan, third-level hospital 800 yuan.

2. Full payment for the first hospitalization, half payment for the second hospitalization, and 100 yuan for the third and above hospitalization.

3 insured outpatient treatment of serious illness, a Qifubiaozhun burden once in a year.

Reimbursement ratio:

The part below 40,000 yuan,

The proportion of payment before retirement is 90% in first-class hospitals, 88% in second-class hospitals and 86% in third-class hospitals.

After retirement, it is 95% in the first-class hospital, 94% in the second-class hospital and 93% in the third-class hospital.

The annual cumulative part of more than 40 thousand yuan,

The proportion of unified payment before retirement is 95%.

97% after retirement (post).

General outpatient service

Proportion: 60% of general outpatient medical expenses incurred by employees participating in medical insurance in designated communities are reimbursed, with the highest annual reimbursement 1 120 yuan.

Reimbursement of serious illness expenses for urban workers