Xiamen medical insurance payment standard 2023

The payment standards for medical social security in Xiamen in 2023 are as follows:

1. In a settlement year, medical expenses less than 654.38+10,000 yuan that meet the reimbursement scope occur:

(1) The threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan;

(2) The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;

2. The reimbursement rate of social security card hospitalization is: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total hospitalization reimbursement of 300,000 yuan. Inpatient deductible line: the standard of the first hospitalization deductible line in a natural year is 1.300 yuan, and then 650 yuan every time;

3. Continuous payment is linked to the reimbursement ratio. After two years of continuous insurance, the reimbursement rate increased to 765,438+0%, and after four years of continuous insurance, the reimbursement rate increased to 72%, and so on. It should be reminded that in different cities, the reimbursement ratio of social security cards is different, which is mainly related to the local medical insurance benefits.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.