Maximum amount of social security reimbursement in Hangzhou

Insurance Bian Xiao helps you answer, and more questions can be answered online.

Use medical insurance card when in hospital.

Measures of Hangzhou Municipality on Basic Medical Security

(eighteen) in a settlement year, the medical expenses incurred by the insured in accordance with the scope of payment of medical insurance expenses shall be handled in accordance with the following provisions:

1, and the maximum amount (subject to the date of discharge) is 1.8 million yuan.

2. Undertake the Qifubiaozhun for one-time hospitalization, specifically: tertiary and corresponding medical institutions (hereinafter referred to as tertiary medical institutions) are in 800 yuan, secondary and corresponding medical institutions (hereinafter referred to as secondary medical institutions) are in 600 yuan, and other medical institutions and community health service institutions are in 300 yuan.

3, Qifubiaozhun above the maximum amount of the following part of the medical expenses, the overall fund to bear the proportion of:

Qifubiaozhun for hospitalization is more than 20,000 yuan (inclusive), 76% before retirement and 82% in tertiary medical institutions after retirement; In secondary medical institutions, 80% before retirement and 85% after retirement; In other medical institutions, 84% before retirement and 88% after retirement; What happened in community health service institutions was 86% before retirement and 92% after retirement.

20,000 yuan to 40,000 yuan (inclusive), 82% before retirement and 88% after retirement; In secondary medical institutions, 85% before retirement and 90% after retirement; In other medical institutions, 88% before retirement and 92% after retirement; In community health service institutions, 90% before retirement and 94% after retirement.

More than 40,000 yuan to 6,543,800 yuan (inclusive) occurred in tertiary medical institutions, 88% before retirement and 94% after retirement; In secondary medical institutions, 90% before retirement and 95% after retirement; In other medical institutions and community health service institutions, 92% before retirement and 96% after retirement.

Before the founding of the People's Republic of China, the old workers who participated in the revolutionary work did not have the hospitalization Qifubiaozhun, and the personal conceit ratio was halved according to the personal conceit ratio of retirees.

(19) In a settlement year, the outpatient medical expenses of the insured for the specified diseases shall be settled by one hospitalization, but there is no hospitalization Qifubiaozhun. The maximum amount of such patients in the settlement year includes outpatient medical expenses and hospitalization medical expenses for specified diseases.

(twenty) the medical expenses above the maximum amount shall be borne by the Medicaid funds for major diseases and individuals, of which the proportion of Medicaid funds for major diseases is: 88% for tertiary medical institutions; 90% of secondary medical institutions; Other medical institutions and community health service institutions 92%.

(twenty-one) in a settlement year, the general outpatient medical expenses incurred by the insured in accordance with the scope of medical insurance payment shall be handled in accordance with the following provisions:

1. First, the personal account is paid by the current fund. If the personal account is insufficient to pay in the current year, the individual shall bear the qifubiaozhun for an outpatient service. Specifically:

(1) Insured before retirement 1000 yuan;

(2) 300 yuan, a retiree of the enterprise and the reference enterprise, and 700 yuan, other retirees;

(3) There is no threshold for old workers who participated in revolutionary work before the founding of the People's Republic of China.

When the insured retires, the outpatient Qifubiaozhun is calculated and determined according to the actual month before and after retirement.

2, outpatient qifubiaozhun above part of the medical expenses, overall fund payment ratio: occurred in tertiary medical institutions, 76% before retirement, 82% after retirement; In secondary medical institutions, 80% before retirement and 85% after retirement; In other medical institutions, 84% before retirement and 88% after retirement; What happened in community health service institutions was 86% before retirement and 92% after retirement. Before the founding of the People's Republic of China, 94%, 95%, 96% and 96% of the old workers took part in the revolutionary work respectively.