Calculation of medical insurance cost?

Is it necessary to charge less than 5000 yuan for medical expenses above the threshold? 1? 7 5000 yuan, 70% for employees under 45 years old, 75% for employees over 45 years old (including 45 years old) and 85% for retirees; Pay for the rest.

5000 yuan to 10000 yuan (including 10000 yuan) for medical expenses, 75% for employees under 45 years old, 80% for employees over 45 years old (including 45 years old) and 90% for retirees; Pay for the rest.

10000 yuan to medical expenses above the top line, 80% of employees under 45 years old, 85% of employees over 45 years old (including 45 years old) and 95% of retirees pay; Pay for the rest.

Payment amount of the overall fund = (total hospitalization expenses-Qifubiaozhun-self-funded part-expenses of Class B drugs and diagnosis and treatment items that pay part of the expenses × 20% )× corresponding percentage coefficient.

2, supplementary medical insurance reimbursement:

(1) threshold fee for basic medical insurance pooling fund

The threshold fee for hospitalization in the former railway hospital: 30% for registered employees and 60% for retirees.

(2) Above the deductible line of the basic medical insurance and below the ceiling line of the overall fund: the balance after the overall fund is paid, and 70% of registered employees and 90% of retirees supplement insurance subsidies.

(3) The top line of the above-mentioned overall funds: 90% of registered employees and retirees receive supplementary insurance subsidies.

(4) Top line of supplementary medical insurance fund (maximum reimbursement within one year): the maximum reimbursement of supplementary insurance within a natural year is 1.5 million yuan.

The reimbursement scope of new rural medical security in Chengdu High-tech Zone

1, reimbursement scope

Where farmers go to the designated social security medical institutions in High-tech Zone (see Annex II) for medical treatment, the medical treatment items and drugs used are within the scope of "Chengdu Medical Service Price" and "Sichuan Basic Medical Insurance Drug Catalogue", which belongs to the reimbursement scope of the new rural insurance fund.

The medical expenses such as work-related injuries and disabilities of farmers are solved by the employer, which is not within the scope of reimbursement of the new agricultural insurance fund.

2. reimbursement standard

(1) outpatient medical expenses

Where outpatient treatment is conducted in the street community health service center (station) where the household registration is located, and the cost of diagnosis and treatment exceeds 10 yuan, the fixed subsidy per person per year is 10 yuan; If it does not exceed 10 yuan, it will be subsidized according to the actual amount.

(2) Hospitalization expenses

Where in the area of community health service institutions in hospital, medical qifubiaozhun 100 yuan, more than 45% reimbursement; Hospitalization in the second-level and second-level hospitals designated by social security in this district, with the medical qifubiaozhun of 300 yuan, and the excess part will be reimbursed by 35% with the hospitalization referral certificate of community health service institutions in this district; The medical qifubiaozhun for hospitalization in the designated tertiary hospitals of social security in this district is 700 yuan, and the excess will be reimbursed by 25% based on the referral certificate of hospitalization in community health service institutions in this district.

The hospitalization expenses incurred by farmers in social security designated medical institutions in different places (outside Chengdu) during their migrant work shall be reimbursed by 25% except for the self-funded part.

The medical expenses of individual hospitalization for many times throughout the year are paid in installments. The annual personal reimbursement amount shall not exceed 12000 yuan.

Farmers who enjoy the new rural insurance in high-tech zones can voluntarily participate in rural medical insurance at the same time, but they can only choose one of them when reimbursing, and cannot be reimbursed repeatedly.

3, reimbursement procedures

The settlement of medical expenses reimbursement adheres to the principle of simplicity, locality and quickness, and two-level settlement is implemented with reference to social security medical reimbursement procedures. That is, community health service institutions (or social security designated medical institutions) and farmers timely settlement; The Social Security Bureau and the community health service institutions shall settle monthly 1 time, and the free medical examination fees provided by the community health service center shall be settled at the end of the year.

(1) outpatient expenses

Patients with my ID card (residence booklet) in the street community health service center (station) for household registration, timely settlement.

(2) Hospitalization expenses

Patients who are hospitalized in community health service institutions in the region and approved to be hospitalized in designated hospitals at or above the first level shall be paid in advance by individual farmers. After discharge from the hospital, the community health service center in the street where the household registration is located will review it and reimburse it on its behalf.

The expenses incurred by migrant farmers in hospitalization in social security designated medical institutions in different places (outside Chengdu) shall be audited by the community health service center of the neighborhood where they live on the basis of the identity certificate issued by the neighborhood office where they are registered after discharge, and reimbursed on their behalf.

In addition:

The "threshold fee" for hospitalization is a "confused account" in the hearts of many medical insurance patients.

The reporter then interviewed Tang Tao, director of the Medical Insurance Department of Chengdu Social Security Bureau. Tang Tao said, "threshold fee" is an inaccurate statement, and the accurate title is "pooling fund Qifubiaozhun" or "Qifubiaozhun". It is not the extra fees charged by the social security bureau or hospitals to inpatients, but a bottom line for the government to reimburse the insured for medical expenses. In other words, the Social Security Bureau only reimburses the expenses between the "deductible line" and the "capping line" according to the regulations, and the expenses below the "deductible line" are borne by the patients themselves. The purpose of setting up "deductible line" is to establish a reasonable sharing mechanism for medical expenses of employees. According to reports, according to the "Interim Measures for Basic Medical Insurance for Urban Workers in Chengdu", "the medical expenses during hospitalization shall be settled by hospitals and medical insurance institutions, and the part that should be borne by individuals shall be settled by hospitals and individuals". The Qifubiaozhun implemented so far in Chengdu is 404.2 yuan for a first-class hospital, 646.72 yuan for a second-class hospital and 970.8 yuan for a third-class hospital. If you stay in a secondary or tertiary hospital for many times in a natural year, you will be reduced by 1%. 200 1 Chengdu Labor Bureau stipulates that the minimum threshold shall not be lower than a first-class hospital.