What is the reimbursement ratio of social security and medical insurance?

The proportion of social security medical reimbursement is:

(A) the proportion of hospitalization reimbursement

1. 90% can be reimbursed for the part of the first-class hospital that exceeds the Qifubiaozhun to the maximum payment limit;

2. For secondary hospitals, 85% can be compensated for the part above the minimum threshold of 1 0,000 yuan; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%;

3 tertiary hospitals, more than Qifubiaozhun to 5000 yuan, can compensate 80%; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

4 retirees can increase 5% on the basis of the above reimbursement ratio.

(2) deductible for hospitalization reimbursement

1, a first-class hospital in 200 yuan;

2, the secondary hospital Wu Bai yuan;

3. 800 yuan, a tertiary hospital;

4, malignant tumor patients, in a medical year for many times due to radiotherapy and chemotherapy medical expenses, only calculate a deductible.

(III) Proportion of outpatient reimbursement for chronic diseases

Outpatient chronic diseases are divided into Class A chronic diseases and Class B chronic diseases.

1. The outpatient medical expenses that meet the requirements due to illness of patients with chronic diseases of Class A shall be compensated by the overall fund by 85%. Outpatient hemodialysis expenses, peritoneal dialysis expenses and cyclosporine A expenses for patients with chronic renal failure (renal failure) after organ transplantation shall be reimbursed on the above basis, and then increased by 10%.

2. B Chronic disease deductible standard: 300 yuan. The outpatient medical expenses incurred by patients with chronic diseases of Class B due to illness can be reimbursed by 80% for the part exceeding the deductible standard, and shall not be higher than the maximum payment limit for chronic diseases within a medical year (or within the validity period).

3. The insured can identify two chronic diseases of Class B at the same time, and calculate the deductible of each disease according to the management of the first two diseases. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

legal ground

Opinions on integrating the basic medical insurance system for urban and rural residents

Article 27 The insured residents shall pay the hospitalization expenses within the policy scope of the designated medical institutions of basic medical insurance in the overall planning area, and the part above the Qifubiaozhun shall be paid by the urban and rural residents' medical insurance fund in proportion; Township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.