Half a year of social security can be reimbursed how much medical expenses

A, hospitalization reimbursement rate

1, first-class hospitals, more than the starting standard to the maximum payment limit can be reimbursed 90%.

2, second-class hospitals, more than the starting standard to 10,000 yuan part of the reimbursement of 85%; more than 10,000 yuan to the maximum payment limit of the part of the reimbursement of 90%.

3, tertiary hospitals, more than the starting standard to five thousand dollars can be compensated 80%; five thousand dollars to 10,000 yuan can be compensated 85%; more than 10,000 yuan to the maximum payment limit can be compensated 90%.

4. Retirees are entitled to an additional 5% on top of the above reimbursement rates.

2, hospitalization reimbursement threshold

1, first-class hospitals two hundred yuan.

2, second-class hospitals 500 yuan.

3, tertiary hospitals eight hundred dollars.

4. Patients with malignant tumors, who have incurred medical expenses due to radiation and chemotherapy several times in a medical year, will only be counted once for the starting line.

Third, the outpatient reimbursement rate of chronic diseases

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

1, Category A chronic disease patients to meet the requirements of outpatient medical costs caused by the disease, 85% reimbursement by the integrated fund. The outpatient hemodialysis cost, peritoneal dialysis cost and the cost of cyclosporine A after organ transplantation for patients with chronic renal failure (renal failure stage) will be reimbursed by 10% on top of the above.

2. The starting line for Class B chronic diseases is 300 RMB. Patients with Class B chronic diseases can be reimbursed 80% of the outpatient medical expenses incurred due to their illnesses that exceed the threshold standard, which cannot be higher than the maximum payment limit for chronic diseases within a medical year (or validity period).

3, the insured can be recognized at the same time two chronic diseases of category B, and based on the first recognized dual-category management, each category of disease for the calculation of the starting line alone. Chronic disease identification management, the maximum payment limit will be in accordance with the integrated fund income and expenditure situation by the human resources and social security departments to adjust in due course. Chronic disease identification standards, rules and procedures, by the municipal human resources and social security administration separately.

Fourth, the maximum reimbursement of health insurance

In a medical year, the integrated fund of the hospitalization of participants incurred medical expenses, chronic outpatient medical expenses do not exceed the maximum payment limit of 250,000 yuan for compensation, the maximum payment limit, if necessary, the relevant departments can be adjusted in accordance with the provisions of the.

Social insurance reimbursement scope

Social insurance account is divided into the basic health insurance fund and personal account, the two payment scope, reimbursement accounting are separate.

First, the individual account can be reimbursed:

1, to the designated retail pharmacy to purchase the money spent.

2, outpatient, emergency spending.

3. Medical expenses that do not meet the starting standard of the basic medical insurance fund.

4. Expenses above the starting standard of the basic medical insurance fund, which are proportionally borne by the insured themselves.

5. The part that is not covered by the individual account is borne by the participants themselves.

2, the basic health insurance fund can be reimbursed:

1, hospitalization medical expenses.

2, emergency rescue and hospitalization.

3, hospitalization before the observation of medical expenses not exceeding 7 days.

4. Outpatient medical expenses for kidney dialysis, radiation therapy and chemotherapy for malignant tumors, and anti-rejection drugs after kidney transplantation.