Reimbursement ratio of Taiyuan City workers' medical insurance tertiary hospitals

Legal analysis: 1, health insurance card reimbursement ratio in the three hospitals

Outpatient: 20% reimbursement for the third-level hospital visits, each visit to the various examination and surgical fees limit of 50 yuan, the prescription drug costs limit of 200 yuan; traditional Chinese medicine invoices accompanied by a prescription limit of 1 yuan per sticker; township cooperative medical outpatient reimbursement of the annual limit of 5,000 yuan.

Hospitalization: reimbursement scope: medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement of 1,000 yuan). 60 years of age or older hospitalized in a health center, the treatment costs and nursing care compensation of 10 yuan per day, limit of 200 yuan. Tertiary hospitals are reimbursed 30%.

2. Reimbursement ratio of social security card in tertiary hospitals

Outpatient: 20% reimbursement for tertiary hospital visits, with a limit of 50 yuan per visit for each examination and surgical procedure, and a limit of 200 yuan for prescription medication; Chinese medicine invoices accompanied by a prescription with a limit of 1 yuan per sticker; and a limit of 5,000 yuan per annum of outpatient reimbursement for township-level cooperative medical services.

Hospitalization: reimbursement scope: medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement of 1,000 yuan). 60 years of age or older hospitalized in a health center, the treatment costs and nursing care compensation of 10 yuan per day, limit of 200 yuan. Tertiary hospitals are reimbursed 30%.

3, Shanxi Taiyuan health insurance reimbursement ratio

From January 2012, the insured person in a first, second and third class fee standard designated medical institutions hospitalization, the starting standard above the maximum reimbursement limit of the following, the employee health insurance reimbursement ratio, the incumbent were 82%, 86%, 90%, and the retirees were 91%, 93%, 95%.

Legal basis: "Chinese People*** and State Social Insurance Law" Article 30 The following medical expenses are not included in the scope of payment of the basic medical insurance fund:

(1) Those that should be paid out of the Workers' Compensation Insurance Fund;

(2) Those that should be borne by a third party;

(3) Those that should be borne by the public*** health;

(4 ) for medical treatment outside the country.

Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the payment is made.