What is the proportion of hospitalization reimbursement for medical insurance for Hefei employees?

Proportion of medical insurance reimbursement for employees in Hefei

Insured persons who are hospitalized for the first time should go to designated medical institutions with their social security cards. Within the scope of medical insurance, the Qifubiaozhun for hospitalization in the first, second and third level hospitals in this city are 200 yuan, 400 yuan and 600 yuan respectively.

According to the Catalogue of Drugs for Basic Medical Insurance and Industrial Injury Insurance in Anhui Province, the drugs used by the insured in hospital are divided into Class A drugs and Class B drugs. The expenses incurred in using Class A drugs shall be paid according to the provisions of basic medical insurance. For the use of Class B drugs, the insured pays a certain proportion first, and the rest is paid according to the provisions of basic medical insurance. The use of drugs outside the drug list will not be reimbursed by the medical insurance fund.

Out-of-pocket expenses refer to the expenses that individuals should bear in medical insurance coverage, including the minimum payment standard (threshold fee) of the overall fund, and the expenses paid by individuals in Class B drugs and medical materials. Out-of-pocket expenses refer to expenses outside the medical insurance catalogue. Designated hospitals should inform the insured in advance when using drugs and medical materials outside the medical insurance catalogue.

The proportion of medical insurance reimbursement in different places is; Proportion of reimbursement for medical insurance in different places: the medical expenses of medical insurance personal account can be transferred to Zigui Medical Insurance Bureau regularly, and hospitals in other provinces are designated hospitals for local medical insurance. The minimum payment standard is 88% above 3000 yuan, 90% above 3000-5000 yuan, 92% above 5000- 10000 yuan, and 95% above 10000 yuan to the maximum payment limit, including 80% for class B drugs and 70% for expensive drugs, special inspection and special treatment. Scope of reimbursement for medical insurance in different places: reimbursement for medical treatment in different places can be divided into internal medicine and other hospitals, and cannot be reported outside medical insurance. All you need is hospitalization procedures, medical list and personal medical insurance card. The reimbursement time is 3-6 months.

A, door (emergency) diagnosis of large Medicaid maximum payment limit of 5500 yuan; Qifubiaozhun is 800 yuan, an on-the-job employee, 700 yuan, a retiree over 60 and under 70, and 600 yuan, a retiree over 70. Reimbursement ratio: the reimbursement ratio of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 65%; The reimbursement rate of first-class hospitals is 75%.

Two, hospitalized in a medical year, the first hospitalization Qifubiaozhun, tertiary hospital 1700 yuan, secondary hospital 1 100 yuan, a hospital in 800 yuan. Secondary and above hospitalization: tertiary hospital 500 yuan, secondary hospital 350 yuan, and primary hospital 270 yuan. Reimbursement ratio: 85% of employees with a minimum threshold of 55,000 yuan will be reimbursed; Retirees are 90%. For medical expenses ranging from 55,000 yuan to 6,543.8+0.5 million yuan, the reimbursement ratio of employees and retirees is 80%. Old workers who took part in the work before the founding of the People's Republic of China were reimbursed 95% in tertiary and secondary hospitals and 97% in primary hospitals. Three, the maximum payment limit of large medical assistance is 300 thousand yuan, and the reimbursement ratio of employees and retirees is 80%.