Proportion of medical insurance reimbursement in Changsha

Changsha medical insurance reimbursement ratio:

1. 70% of tertiary standard hospitals (including township hospitals and community health service institutions);

2. 60% of the secondary charging standard hospitals;

3. 50% of the first-class standard hospitals;

4. Reimbursement for special diseases is 50%;

5. 50% reimbursement for ordinary students, minors and college students;

6. Emergency rescue and death rescue (72 hours) 50% reimbursement for hospitalization and rescue medical expenses, with no Qifubiaozhun.

Changsha medical insurance reimbursement standard:

(1) township hospitals and community health service institutions 100 yuan;

(2) 200 yuan, a third-class charging standard hospital;

③ 400 yuan, a secondary charging standard hospital;

(4) 700 yuan, a first-class standard hospital.

⑤ Ordinary students, minors and college students are 6,543,800 yuan, and adults are 60,000 yuan.

The proportion of medical insurance reimbursement for urban and rural residents in Changsha is as follows:

First, outpatient medical expenses reimbursement:

1. Village clinics can be reimbursed 70%, and individuals are responsible for 30%;

2 township hospitals, community health service centers, can be reimbursed 60%, personal responsibility 40%;

3. Universities, hospitals and medical offices can be reimbursed 70%, and the insured college students and ordinary students in the school are responsible for 30% respectively. In a settlement year, the maximum reimbursement amount of outpatient medical expenses within the scope of medical insurance is 800.

Two, hospitalization medical expenses reimbursement:

1, township hospitals and community health service centers can be reimbursed 85% after deducting the deductible standard of 200;

2. Third-level standard medical institutions (county-level third-level standard medical institutions and second-level standard medical institutions) can be reimbursed 70% after deducting the deductible standard of 300;

3. Medical institutions with Class II charges can be reimbursed 65% after deducting the deductible standard of 500;

4. Municipal Class B medical institutions can be reimbursed 60% after deducting the deductible standard 1 100.

In a settlement year, the maximum reimbursable amount of hospitalization medical expenses within the scope of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million;

Three, maternity medical expenses reimbursement:

1. Maximum subsidy for flat production1300;

2. Maximum subsidy for cesarean section 1600.

The hospitalization expenses incurred by pregnant women due to high-risk treatment can be reimbursed and paid according to the relevant hospitalization standards.

Fourth, the serious illness medical treatment:

1, the standard of ordinary people's deductible line is 22324; The threshold for needy people (i.e. poor people, low-income households and people returning to poverty) is reduced by 50% to1162 yuan;

2. The reimbursement standards for ordinary people are: 60% from 0 to 30,000, 65% from 30,000 to 80,000 (inclusive), 75% from 80,000 to 15000 (inclusive), and 85% above 15000; The reimbursement standards for people in difficulty are: 65% for 0-30,000, 70% for 30-80,000 (inclusive), 80% for 80,000-6,543.8+0.5 million (inclusive), and 90% for 6,543.8+0.5 million;

3. The annual quota of ordinary people is unified to 400,000; There is no capping line for those who need it.

legal ground

Article 7 The administrative department of social insurance in the State Council is responsible for the management of social insurance throughout the country, and other relevant departments in the State Council are responsible for the relevant social insurance work within their respective functions and duties.

The social insurance administrative department of the local people's government at or above the county level shall be responsible for the social insurance management within its administrative area, and other relevant departments of the local people's government at or above the county level shall be responsible for the relevant social insurance work within their respective functions and duties.

Article 73 Social insurance agencies shall establish and improve business, financial, safety and risk management systems.

Social insurance agencies shall pay social insurance benefits in full and on time.