Taiyuan city medical insurance reimbursement scope

I. The scope of reimbursement of medical insurance for urban residents in Taiyuan City is as follows:

(1) medical expenses for hospitalization;

(2) medical expenses incurred within 7 days prior to the date of emergency detention and transfer to inpatient treatment;

(3) medical expenses in compliance with the provisions of special outpatient medical treatment for urban residents;

(4) other expenses in compliance with the provisions.

The standard reimbursement rate

The starting standard and reimbursement rate of basic medical insurance for urban residents are determined according to the categories of the insured.

1. It is students and children. In a billing year, incurring medical expenses of less than 180,000 yuan that are eligible for reimbursement, the starting standard for tertiary hospitals is 500 yuan, and the reimbursement rate is 55%; the starting standard for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; and primary hospitals do not set a starting standard, and the reimbursement rate is 65%.

2. It is the elderly who are over 70 years old. In a billing year, the medical expenses of less than 100,000 yuan that meet the scope of reimbursement, the starting standard for third-level hospitals is 500 yuan, and the reimbursement rate is 50%; the starting standard for second-level hospitals is 300 yuan, and the reimbursement rate is 60%; and first-level hospitals don't have a starting standard, and the reimbursement rate is 65%.

3. Other urban residents. In a billing year, the occurrence of medical expenses that meet the scope of reimbursement of less than 100,000 yuan, the starting standard for third-level hospitals is 500 yuan, the reimbursement rate is 50%; second-level hospitals hospitalization starting standard is 300 yuan, the reimbursement rate is 55%; first-level hospitals do not set the starting standard, the reimbursement rate is 60%.