What is the reimbursement rate of Changzhou medical insurance

What is the reimbursement rate of Changzhou medical insurance? In the general outpatient clinic in the first medical institution, the medical insurance fund pays 50%, and then to the second and third level medical institutions, the medical insurance fund pays 40%; the maximum reimbursement for specific diseases is 85%; the maximum reimbursement for inpatient hospitalization co-ordination of the first and second level medical institutions is 95%. General outpatient coordination within an insurance year... Want to know more about Changzhou medical insurance reimbursement rate is how much knowledge, follow me together.

What is the reimbursement rate of Changzhou medical insurance? General outpatient in the first medical institutions, the health insurance fund to pay 50%, after the second and third level of medical institutions, the health insurance fund to pay 40%; the maximum reimbursement of 85% of specific diseases; hospitalization co-ordination of the first and second level of medical institutions, the maximum reimbursement of 95%.

(A) outpatient coordination

1, general outpatient coordination

a year of insurance, the insured person incurred in line with the provisions of the general outpatient medical expenses, first by the individual out-of-pocket accumulative total of 200 yuan, for more than 200 yuan to 1500 yuan of the cost of the first visit to the medical institutions, the medical insurance fund to pay 50%, according to the provisions of the referral procedures to the second and third-tier institutions, the medical insurance fund to pay 50%, the medical insurance fund to pay for the second and third-tier institutions. The medical insurance fund pays 40% of the cost of consultation at the first medical institution.

2. Outpatient Specific Diseases

If the insured person suffers from severe mental illness or epilepsy with mental disorder, after confirmation by the Municipal Medical Insurance Center, the medical insurance fund will pay 40% of the expenses incurred in the outpatient clinic for the use of medicines for the treatment of mental illness up to RMB 200 per month for the part of the medical insurance fund for the "minor residents" and "college students". For the portion of the cost of cataract implantation within 3,000 yuan, the resident medical insurance fund pays 85% for "minor residents" and "college students" and 75% for other people.

3. Outpatient Major Diseases

The starting standard for settlement of outpatient major disease expenses is 800 RMB/year, and expenses below the starting standard will be borne by the individual, while expenses exceeding the starting standard will be paid in accordance with the settlement method for inpatient hospitalization. At the same time, the implementation of limit management: organ transplantation requires anti-rejection treatment limit standard for the first year after the operation 100000 yuan / year, the second year after the operation 70,000 yuan / year, the third year after the operation and after 50,000 yuan / year; hemophilia treatment limit standard of 8000 yuan / year; aplastic anemia treatment limit standard of 15,000 yuan / year.

(B) hospitalization coordination

in the third-level medical institutions, "minor residents" and "college students" starting standard is 400 yuan / time, above the starting standard to the maximum limit of 85% of the residents of the medical insurance fund to pay for other people. For other people, the starting payment standard is 800 yuan per visit, and the resident medical insurance fund pays 75% of the total amount between the starting payment standard and the maximum limit; for visits to first- or second-level medical institutions, the starting payment standard for "minor residents" and "university students" is 200 yuan per visit, and the starting payment standard for "minor residents" and "university students" is 200 yuan per visit, and the resident medical insurance fund pays 75% of the total amount between the starting payment standard and the maximum limit. The starting standard for "minor residents" and "college students" in first and second-tier medical institutions is 200 yuan / time, the starting standard to the maximum limit of 95% paid by the residents of the medical insurance fund, the starting standard for other people is 400 yuan / time, the starting standard to the maximum limit of 85% paid by the residents of the medical insurance fund.

Tips:

The above is the introduction of Changzhou medical insurance reimbursement ratio, outpatient costs for the first time in a year using the basic medical insurance payment, whether employees or retirees, the starting amount of 200 yuan, hospitalization costs for the starting standard of 800 yuan / times, "minor residents" and "college students". The minimum payment for hospitalization is 800 yuan per visit, and the minimum payment for "minor residents" and "college students" is 400 yuan per visit.