Proportion of reimbursement for social security clinics in Foshan City

20 19 Foshan urban and rural medical insurance reimbursement ratio, Foshan urban and rural residents medical insurance reimbursement process.

General outpatient medical insurance reimbursement treatment for community health service institutions, town (street) hospitals and first-class hospitals into a class of medical institutions, reimbursement of 90%; The secondary hospital is a secondary medical institution with 70% reimbursement; The tertiary hospital is a tertiary medical institution, and the reimbursement is 40%.

When the insured person goes to a medical institution for general outpatient treatment, the prescribed drug expenses and the expenses incurred by the routine basic medical services (three routines, electrocardiogram, black-and-white B-ultrasound, chest X-ray and blood sugar monitoring) included in the scope of reimbursement shall be paid by the pooling fund according to the following provisions: namely, 90% of the community health service institutions, town (street) hospitals and first-class hospitals affiliated to the first-class medical institutions; 70% of secondary hospitals belong to secondary medical institutions; 40% of tertiary hospitals belong to tertiary medical institutions.

The hospitalization deductible standard of hospitalization medical insurance reimbursement treatment in Gaoming District is: tertiary medical institution 1.200 yuan/time, secondary medical institution 600 yuan/time, and primary medical institution 300 yuan/time.

The medical expenses incurred by the insured in the designated medical institutions in the city above Qifubiaozhun and included in the scope of payment by the overall fund shall be paid to the maximum payment limit according to the type of hospital: 95% in the first-level medical institutions, 90% in the second-level medical institutions, and 85% in the third-level medical institutions (90% in the surgical treatment of malignant tumors, cardiac and brain diseases, liver, kidney and bone marrow transplantation).

In Gaoming District, there is no deductible line for outpatient specific diseases and chronic diseases, and the reimbursement ratio is the same as that of hospitalization (95% in first-class medical institutions, 90% in second-class medical institutions, 85% in third-class medical institutions, and 90% in third-class hospitals); The annual quota is divided into three grades, the low-grade quota is 4500 ~ 5500 yuan, the middle-grade quota is 45000 ~ 45000 yuan, and the high-grade quota is 654.38+ 10000 yuan.

There is no deductible for outpatient chronic diseases, and the reimbursement rate is 85% for first-class medical institutions, 80% for second-class medical institutions and 75% for third-class medical institutions, with an annual limit of 4,500-5,500 yuan.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.