Is there a cap on Social Security Medicare reimbursements?

There is an upper limit.

Taking outpatient reimbursement as an example:

Village health clinics and village center health clinics are reimbursed 60%, with a limit of $10 per visit for prescription drugs, and a limit of $50 for temporary rehydration of prescription drugs by the clinic doctor;

Township health hospitals are reimbursed 40%, with a limit of $50 per visit for each checkup and surgery, and a limit of $100 for prescription drugs;

30% reimbursement for visits to secondary hospitals, with a limit of 50 yuan per visit for each examination and surgical procedure, and a limit of 200 yuan for prescription drugs;

20% reimbursement for visits to tertiary hospitals, with a limit of 50 yuan per visit for each examination and surgical procedure, and a limit of 200 yuan for prescription drugs;

1 yuan per sticker of traditional Chinese medicine for which a prescription is attached to the invoice; and an annual limit of 5,000 yuan on outpatient reimbursement for cooperative medical care at the town level. Yuan.

Expanded Information:

Reimbursement Ratio:

1. Hospitalization

Reimbursement Scope:

Medicine: Auxiliary Examinations: ECG, X-ray, Fluoroscopy, and other tests. Electroencephalogram, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other various examination fees limit of 200 yuan;

Surgical costs (with reference to the national standard, more than 1,000 yuan will be reimbursed according to the 1,000 yuan). 60 years of age or older hospitalized in a health center, the treatment costs and nursing care costs of compensation of 10 yuan per day, a limit of 200 yuan.

Reimbursement rates: town health centers reimburse 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.

2. Major Diseases

Any hospitalized patient who participates in the cooperative medical care system will be reimbursed for the one-time or yearly accumulative reportable medical expenses of more than 5,000 yuan, i.e., 65% of 5,001-10,000 yuan, and 70% of 10,001-18,000 yuan.

The annual limit of compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy is 11,000 yuan.

3. Exemptions

Medical expenses for self-medical treatment (medical treatment in unspecified hospitals or without referral orders), self-purchased medicines, medicines that cannot be reimbursed under public medical care regulations, and medical expenses that are not in line with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional fees, blood transfusion fees (except for those who have family blood storage, which is reimbursed according to the relevant regulations), air-conditioning and heating costs, ambulance charges, and special Other expenses such as nursing fees; medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice; orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.; reimbursement within the scope of reimbursement, part of the limit outside the scope of reimbursement.

Baidu Encyclopedia-Social Security Medical Insurance

Baidu Encyclopedia-Medicare Reimbursement Ratio