Proportion of medical insurance reimbursement for employees in Chengdu

First, the proportion of medical insurance reimbursement in Chengdu:

1, employee medical insurance

First-class hospital: 200 yuan, deductible, 92% reimbursement.

Secondary hospital: 400 yuan, deductible, 90% reimbursement.

Tertiary hospital: 800 yuan, deductible, 85% reimbursement.

2. "Residents' medical insurance"

First-class hospital: the deductible line 100 yuan, and the reimbursement is based on 60% of the first grade, 80% of the second grade and 85% of the third grade.

Second-level hospital: 200 yuan, deductible, 55% for the first file, 65% for the second file and 80% for the third file.

Third-level hospital: 500 yuan, deductible line, 35% for the first file, 50% for the second file and 65% for the third file.

Community health service institutions and township hospitals: the deductible line 100 yuan, and the reimbursement ratio is 65% for the first file, 90% for the second file and 90% for the third file.

Note: There are three levels of residents' medical insurance, and the difference lies in the different premiums. Grade I 100 Yuan, Grade II 200 yuan, Grade III 300 yuan. Self-funded drugs and imported drugs that are not in the social security catalogue cannot be reimbursed. The maximum reimbursement limit for drugs that meet social security is 350,000/year for employee medical insurance, 40,000/year for first-class medical insurance, 50,000/year for second-class medical insurance, and 60,000/year for resident medical insurance. The part that exceeds the annual limit is paid by itself.

Second, the reimbursement conditions of medical insurance

1, individuals begin to enjoy medical insurance benefits after six months of continuous payment for the first time.

2 unemployed persons who participate in (continue to) medical insurance during the period of receiving unemployment insurance benefits or within 60 days after receiving unemployment insurance benefits shall enjoy medical insurance benefits from the next month of payment.

Chengdu medical insurance reimbursement scope:

Third, the scope of reimbursement

It mainly includes the doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization miscellaneous expenses, operation expenses and various inspection expenses.

Fourth, the scope of non-reimbursement

(1) Self-seeking medical treatment (no designated hospital or referral form), self-purchased drugs, drugs that cannot be reimbursed according to the regulations of free medical care, and medical expenses that do not conform to family planning.

(2) Outpatient treatment fee, visiting fee, hospitalization fee, food fee, escort fee, nutrition fee, blood transfusion fee (except for family blood donors, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc.

(3) Medical expenses for car accidents, fights, suicides, alcoholism, work-related injuries and medical accidents.

(4) Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc.

(5) Within the scope of reimbursement, beyond the limit.

Policy interpretation of verb (verb's abbreviation)

Ministry of Human Resources and Social Security and the Ministry of Finance issued the "Notice on Doing a Good Job in Direct Settlement of Medical Expenses of Inpatients in Different Provinces of Basic Medical Insurance", which made it clear that:

1 and 20 17 gradually solve the direct settlement of hospitalization expenses for retirees placed in different places across provinces, and expand to the direct settlement of hospitalization expenses for those who meet the referral conditions at the end of the year;

2, combined with the local household registration and residence permit system reform, and gradually will be long-term residents and residents in different places into the direct settlement of medical expenses in different places.

6. What changes have taken place in the medical insurance policy for urban and rural residents in Chengdu?

1. The supplementary medical insurance for serious and serious diseases has improved the level of protection for serious and serious diseases, and the reimbursement ratio is reimbursed in stages and in proportion. The reimbursement rate of basic medical insurance with reimbursement range of 100% and above 50,000 yuan reaches 90%.

2. The medical insurance system for serious and serious diseases has been established, and some targeted drugs and chemotherapy drugs, highly disabling diseases and rare diseases (orphan drugs) not covered by the basic medical insurance have been included in the reimbursement scope.

3. The fund-raising level of some people has been reduced, and students and children (including college students) will no longer pay supplementary medical insurance for serious illness and medical insurance for serious and serious diseases after paying the premium of basic medical insurance for urban and rural residents.

4. The proportion of hospitalization reimbursement for some people has been increased, and the proportion of hospitalization reimbursement for students and children (including college students) in tertiary hospitals has increased by 5 percentage points.

Legal basis:

Notice of Ministry of Human Resources and Social Security and the Ministry of Finance on Doing a Good Job in Direct Settlement of Inter-provincial Inpatient Medical Expenses of Basic Medical Insurance.

(1) specification is convenient. Insist on providing convenient and fast settlement services for the insured. The insured person only needs to pay the hospitalization medical expenses borne by the individual according to the regulations, and other expenses are paid by the medical handling institutions and designated medical institutions according to the agreement.

(2) Step by step. Adhere to the first province and then cross-province, first hospitalization and then outpatient service, first resettlement in different places and then referral, first basic medical insurance and then supplementary insurance, combined with the actual construction of information systems in various places, give priority to connecting centralized areas for medical treatment in different places, and steadily and comprehensively promote direct settlement.

(3) seek medical treatment in an orderly manner. Adhere to the integration of urban and rural medical insurance system, combined with the promotion of graded diagnosis and treatment system, establish a reasonable referral mechanism, and guide the insured to seek medical treatment in an orderly manner.

(4) Unified management. Adhere to the basic medical insurance policy, the process of medical treatment in different places and the settlement method are basically stable, and integrate medical treatment in different places into the scope of management services such as negotiation, total control, intelligent monitoring, medical insurance doctor management and medical service quality supervision between medical institutions and designated medical institutions.