What is the reimbursement standard for serious illness of medical insurance bureau?

1. What is the medical expenses that exceed the maximum payment limit of the basic medical pooling fund? 0-40,000 yuan (inclusive), 85% reimbursement;

2. If the medical expenses exceeding the maximum payment limit of the basic medical pooling fund are less than 40,000-80,000 yuan (inclusive), 90% will be reimbursed;

3. More than 80,000 yuan of medical expenses exceeding the maximum payment limit of the basic medical pooling fund, 95% of which will be reimbursed.

The payment scope of the unit serious illness medical insurance co-ordination fund is the one-time hospitalization medical expenses or the accumulated part exceeding 2000 yuan within 30 days of the employee's illness or non-work-related injury (excluding the self-funded part and the personal burden part), and the unit serious illness medical insurance adopts the method of step-by-step calculation and accumulated payment:

1 and 90% of the following part of 2000 -5000 yuan (inclusive);

2, 5000 yuan-10/00000 yuan (inclusive) the following part to pay 85%;

3, 10000 yuan -30000 yuan (inclusive) the following part pays 80%;

4、? 85% of the following part of 30,000-50,000 yuan (inclusive);

Pay 90% for 50,000 yuan and above.

The goal of extended information serious illness insurance is to avoid catastrophic medical expenses for residents. Therefore, the installment reimbursement is implemented. The higher the medical expenses, the higher the payment ratio. The reimbursement rate of the deductible line is 50% for 0 ~ 20,000 yuan (including 20,000 yuan), 60% for 20 ~ 40,000 yuan (including 40,000 yuan), 70% for 40 ~ 60,000 yuan (including 60,000 yuan), and 80% for more than 60,000 yuan.

It is reported that the actual payment ratio of urban residents' medical insurance and the new rural cooperative medical system within one year is not less than 53%. Specific indicators such as financing standard, deductible line, scope and proportion of segmented reimbursement will be adjusted year by year according to the level of economic and social development, financing level and growth level of medical expenses, so as to minimize the burden of personal medical expenses.

In addition, if it is necessary to transfer to other areas for treatment, according to the Administrative Measures for Going Abroad for Medical Treatment, if the municipal medical insurance agency approves and handles the transfer procedures, the proportion of reasonable medical expenses outside the critical illness deductible line will be unified to 50%.

Baidu encyclopedia-medical insurance reimbursement ratio