What is the proportion of reimbursement for serious illness in medical insurance for urban residents?

The proportion of reimbursement for serious illness in medical insurance for urban residents is as follows:

1, outpatient reimbursement ratio standard:

(1) saw a doctor in the local village center clinic, and the reimbursement rate was 60%, which was covered by medical insurance. The limit of medical expenses per visit 10 yuan, and the limit of prescription expenses for temporary rehydration for doctors in health centers is 50 yuan;

(2) The reimbursement rate for medical treatment in the local town health center is 40%, and the examination fee and operation fee required for each medical treatment are limited to 50 yuan, and the prescription fee is limited to 100 yuan; In other words, if the medical expenses you prescribe are between 200-500 yuan, you can only reimburse 100 yuan;

(3) The reimbursement rate for medical treatment in local secondary hospitals is 30%, and the examination fee and operation fee for each visit are limited to 50 yuan, and the prescription fee is limited to 200 yuan;

(4) The reimbursement rate for medical treatment in a local tertiary hospital is 20%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

2, hospitalization reimbursement ratio standard:

(1) Proportional standard for reimbursement of auxiliary examination expenses: the examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance shall be reimbursed to 200 yuan; In other words, if 400 yuan is needed for filming, 200 yuan can only be reimbursed at the end of reimbursement;

(2) Proportion standard for reimbursement of operation expenses: refer to the national standard, if it exceeds 1 1,000 yuan, it will be reimbursed as 1 1,000 yuan; The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan;

(3) The reimbursement rate standard of hospitals at all levels: the reimbursement rate of town hospitals is 60%; The reimbursement rate of secondary hospitals is 40%; The reimbursement rate of tertiary hospitals is 30%.

3, serious illness reimbursement ratio standard:

(1) For those who participate in local medical insurance payment, the proportion of reimbursement for serious illness is one-time compensation or the annual medical expenses exceed 5,000 yuan. If the medical expenses range from 500 1 to 10000 yuan, the compensation standard is 65%. If the medical expenses range from 100 1 to 65438+.

(2) For those who participate in local medical insurance payment, the proportion of reimbursement for serious illness is one-time compensation or the annual medical expenses are more than 5,000 yuan. If the medical expenses range from 500 1 to 10000 yuan, the compensation standard is 65%. If the medical expenses are between 100 1 to 18000 yuan, the compensation standard is 65%.

(3) For those who have participated in the local medical insurance payment, the one-year reimbursement rate limit for hemodialysis and radiotherapy and chemotherapy compensation in the township cooperative medical system and uremia outpatient department is 1 1000 yuan.

To sum up, the reimbursement rate of serious illness medical insurance for urban and rural residents is between 50% and 80%, and the reimbursement amount is between 500,000 yuan and 200,000 yuan, while the reimbursement rate of serious illness medical insurance in rural areas is between 80% and 90%, and the reimbursement amount is between 300,000 yuan and 65438+10,000 yuan.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.