Zhengzhou employee health insurance reimbursement rate 2024

The reimbursement ratio of Zhengzhou employee health insurance varies according to the level of different medical institutions and whether or not you are employed. Here are the specific reimbursement rates:

Outpatient reimbursement rates:

The starting standard for general outpatient coordination is 40 yuan per visit, and the starting standard for township health centers? , community health center? There is no starting standard.

Third-class A designated medical institutions? The payment ratio for outpatient visits is 55%.

The payment ratio for outpatient visits to other grades of designated medical institutions at the provincial, municipal and county levels is 60%.

The payment ratio for outpatient visits to township health centers and community health centers is 65%.

Hospitalization reimbursement rate:

The starting standard for hospitalization in designated hospitals at the township level (township health centers and community health service centers) is 200 yuan, and the reimbursement rate is 95%.

The starting standard for hospitalization in county-level (first, second and third level), municipal-level (second level) and provincial-level (first level) designated hospitals is 300 yuan, and the reimbursement rate is 95%.

The starting standard for hospitalization in municipal (Grade 3) and provincial (Grade 2, Grade 3 non-A) designated hospitals is 600 yuan, and the reimbursement rate is 90%.

The starting standard for hospitalization in provincial-level (Grade 3A) designated hospitals is 900 yuan, and the reimbursement rate is 88%.

Reimbursement for major diseases:

The reimbursement rate of Zhengzhou urban workers' health insurance for serious and major diseases is 85%.

Reimbursement rate for retired workers' hospitalization:

The starting standard for hospitalization in designated hospitals at the township level (township health centers and community health service institutions) is 200 yuan, and the reimbursement rate is 97%.

The starting standard for hospitalization at county-level (first, second and third level), municipal-level (second level) and provincial-level (first level) designated hospitals is RMB 300, and the reimbursement rate is 97%.

The starting standard for hospitalization in municipal (Grade 3) and provincial (Grade 2, Grade 3 non-A) designated hospitals is 600 yuan, and the reimbursement rate is 95%.

The starting standard for hospitalization at provincial (Grade 3A) designated hospitals is 900 yuan, and the reimbursement rate is 93%.

Outpatient medical insurance reimbursement process and precautions:

The following documents should be brought when reimbursement is made:

1. Original ID card or social security card;

2. Original diagnosis certificate of disease issued by a specialist doctor of the designated medical institution;

3. Outpatient medical records, examination, test results report cards and other original medical documents;

4.

4. The original financial and tax unified medical institutions outpatient fee receipts;

5. The original computer-printed list of outpatient costs in the hospital or the original payment of the prescription issued by the doctor;

6. Designated drugstores: the original unified invoice for the sale of tax commodities and the original computer-printed list;

7. If it is a proxy for someone else, you will need to provide an original ID card of the person who is doing it on behalf of the proxy.

Bring all the above information to the relevant departments of the local social security center to apply for processing, after review, the information is complete and meet the conditions, it can be instantly processed. When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the individual account of medical insurance in the current social security year will be deducted first, and then the amount to be reimbursed will be approved.

In summary: urban workers' medical insurance is integrated at the municipal level, with unified policies, standards and processes across the city.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 2

The state establishes a social insurance system of basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, and other social insurance systems, to protect the citizens' rights to obtain material assistance from the state and society in accordance with the law in the event of old age, sickness, industrial injury, unemployment and childbirth. rights.

Article 17

If an individual who has participated in basic old-age pension insurance dies of illness or not due to work, his or her surviving family members may receive funeral grants and pensions; and if he or she becomes disabled and totally incapacitated for work due to illness or not due to work when he or she has not yet attained the legal age of retirement, he or she may receive invalidity allowances. The required funds are paid from the basic pension insurance fund.

Article 26

The standards of treatment for 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.

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.