List of reimbursement ratio of medical insurance in Zibo

Zibo Social Security Card Reimbursement Scope

The contribution ratio of medical insurance for enterprise employees is: 8% of the unit contribution base and 2% of the individual contribution base of employees. However, it should be reminded that the base of employee medical insurance payment in different provinces and cities is different. Taking Guangzhou as an example, the base of medical insurance payment for employees in Guangzhou is adjusted from 17424 yuan to 1856 1 yuan, and the lower limit is adjusted from 3485 yuan to 37 12 yuan. In addition, the payment base for flexible employees to participate in social medical insurance for employees is 60% of the average monthly salary of employees in this city last year, that is, 37 12 yuan.

It can be answered from the aspects of reimbursement ratio, general outpatient reimbursement, and serious illness reimbursement.

1. Reimbursement ratio of medical insurance for enterprise employees

(a) according to the first payment, in the implementation of the basic drug system, 80% of the hospitalization expenses are paid (90% of the basic drug payment), and 60% of the hospitalization expenses are paid in the implementation of the basic drug system; Secondary hospitals pay 58%; The tertiary hospital pays 45%.

(2) According to the second payment, the first-level hospital pays 85% (90% for essential drugs), the second-level hospital pays 70%, and the third-level hospital pays 60%.

(three) minor residents and special groups enjoy the medical insurance benefits of class II payment.

Qifubiaozhun for reimbursement of hospitalization medical expenses: 300 yuan, a first-class hospital, 500 yuan, a second-class hospital and 700 yuan, a third-class hospital. Malignant tumor patients who have been hospitalized for chemotherapy and radiotherapy for many times in a medical insurance year will only be deducted once.

2. The reimbursement ratio of outpatient medical insurance for enterprise employees.

Insured workers in designated community health service centers or township hospitals in accordance with the provisions of the outpatient medical expenses, paid by the general outpatient co-ordination fund according to the proportion of 50%. There is no deductible for the general outpatient expenses incurred by the insured workers in the basic medical institutions that implement the national basic drug system; In other primary medical institutions, the minimum payment standard was reduced from 40 yuan to 30 yuan. The reimbursement limit for the first-class general outpatient service was raised from 60 yuan to 80 yuan; The second payment was made in 200 yuan.

3. Serious illness medical insurance benefits

Degree, the deductible line of serious illness insurance is1.20 thousand yuan, that is, after the reimbursement of basic medical insurance for residents, the part of the compliance medical expenses borne by individuals below1.20 thousand yuan will not be compensated. 50% compensation will be given to the part where the compliance medical expenses borne by individuals exceed 1 .2000 yuan (including1.2000 yuan) and are less than110000 yuan; 65.438+10,000 yuan (including 6.5438+10,000 yuan) and 60% compensation for the part less than 200,000 yuan; More than 200,000 yuan (including 200,000 yuan) will be compensated by 65%. In a medical year, the maximum payment for serious illness insurance is 300,000 yuan per person. This standard will still be implemented before the relevant departments introduce a new serious illness insurance policy.

The individual payment standard of medical insurance for residents in our city is uniformly adjusted to per person 160 yuan. According to the change of financing level, according to the principle of "fixed expenditure based on income, balance of payments and slight balance".

legal ground

People's Republic of China (PRC) social insurance law

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.