What is the proportion of social security reimbursement in Chongqing?

Proportion of reimbursement of medical insurance for urban residents in Chongqing

1, intermittent insurance, general outpatient fixed lump sum fund is no longer carried forward.

The general outpatient expenses incurred by residents' medical insurance participants can be covered by the general outpatient quota, and the quota of 20 16 years is 80 yuan per person. The fixed lump sum fund can be used for the insured person, relatives or designated personnel to purchase outpatient treatment drugs or pay hospitalization expenses. The unused balance of the current year can be carried forward across years.

The insured can use it in full within the quota of general outpatient service, and the reimbursement ratio is 100%. It should be noted that the general outpatient fixed contract fund belongs to the residents' medical insurance fund and is not owned by individuals. For residents who do not have continuous insurance contributions, unused fixed lump sum funds will no longer be carried forward.

2, can be reimbursed in proportion at designated primary medical institutions 100 yuan.

20 17 insured urban and rural residents and self-insured newborns can also enjoy reimbursement for general outpatient service in primary medical institutions on the basis of fixed lump sum reimbursement for outpatient service. The reimbursement standard is: 60% of the insured persons who have been designated in primary medical institutions (township hospitals, community service centers (stations), village clinics and social medical institutions below the first level) and have incurred general outpatient expenses in medical insurance coverage. The insured persons who are not designated in primary medical institutions belong to the general outpatient expenses in medical insurance coverage, and are reimbursed by the residents' medical insurance fund at a rate of 60%. The annual reimbursement limit is 60 yuan/person.

The general outpatient service for college students in the academic year of 2065438+September 2006-2065438+July 2007 was arranged by the internal medical institution of the unit according to the quota standard of 100 yuan per person, and the fund was special. The reimbursement ratio and reimbursement limit of general outpatient service shall be implemented in accordance with the relevant provisions of our city.

3. How much can I reimburse after participating in the insurance?

Calculation method: Reimbursement amount = (medical expenses within the scope of medical insurance reimbursement-deductible expenses) × reimbursement ratio.

The threshold fee 100 yuan/time is deducted from the designated medical institutions at the first level and below, and 80% of the first-class drugs are reimbursed and 85% of the second-class drugs are reimbursed; Pay 10% for Class B drugs first, and then reimburse them according to the proportion of 80% and 85%;

The second-level designated medical institutions deduct the threshold fee of 300 yuan/time, and the first-class reimbursement of Class A drugs: 60% for Class I and 65% for Class II; Pay 10% for Class B drugs first, and then reimburse them according to the proportion of 60% and 65%;

Third-level designated medical institutions deduct the threshold fee 800 yuan/time, and class A drugs are reimbursed: 40% for class I and 45% for class II; Pay 10% for Class B drugs first, and then reimburse them according to the proportion of 40% and 45%;

At present, the first file of the upper limit line is 80,000 yuan, and the second file is 1.2 million yuan.