How many grades are there in medical insurance?

Medical insurance is divided into three grades: basic medical care level 1, basic medical care level 2 and basic medical care level 3, and its payment, treatment and adaptation to the crowd are different.

Medical principles:

1. First-class insured: see a doctor at any designated medical institution in the city.

2. Class II insured persons: outpatients seek medical treatment in the binding community health center, hospitalized in any designated medical institution in the city, and seriously ill outpatients seek medical treatment in specified medical institutions.

3. Three-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.

Scope of medical insurance reimbursement

1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents. The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%. Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4, serious illness insurance reimbursement insured suffering from a serious illness, in the city's medical insurance designated medical institutions, in line with the provisions of the city's medical insurance personal responsibility, into the scope of payment of residents' serious illness insurance, 50% reimbursement by the serious illness insurance fund. That is, reimbursement amount = self-funded part ×50%

Legal basis:

People's Republic of China (PRC) (China) Social Insurance Law

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Article 25 The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.