Shaanxi social security hospitalization reimbursement rate

Employees and retirees in an insurance year in the hospitalization, outpatient emergency rescue or outpatient treatment of some serious illnesses in the medical expenses accumulated over the integrated fund of the "ceiling line", the commercial insurance company in accordance with the segmentation of the calculation, the cumulative payment of the method is responsible for claims, but the individual must also be However, individuals are also required to bear a certain proportion of the costs, specifically. (!) For medical expenses above 30,000 yuan up to and including 100,000 yuan, the large medical insurance premium pays 94%, and the individual pays 6% out of pocket; (2) for medical expenses above 100,000 yuan up to and including 200,000 yuan, the large medical insurance premium pays 96%, and the individual pays 4% out of pocket; (3) for medical expenses above 200,000 yuan, the large medical insurance premium pays 98%, and the individual pays 2% out of pocket. In one year, the large medical insurance premium pays a maximum of 300,000 yuan per person on a pro rata basis.

Article 29 of the Social Insurance Law of the People's Republic of China (PRC) stipulates that the portion of the insured person's medical expenses that should be paid for by the basic medical insurance fund shall be settled directly by the social insurance administration organization with the medical institutions and pharmaceutical business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance treatment by insured persons.