Proportion of hospitalization reimbursement for personal social security

Reimbursement for medical treatment in village clinics and village center clinics is 60%, and the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan;

40% reimbursement for medical treatment in the town health center, the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drugs is 100 yuan;

Second-level hospitals will be reimbursed 30% for medical treatment, with each examination fee and operation fee limited to 50 yuan and prescription drug fee limited to 200 yuan;

Third-level hospitals will be reimbursed 20% for medical treatment. The examination fee and operation fee for each visit are limited to 50 yuan, and the prescription drug fee is limited to 200 yuan;

Chinese medicine invoice with prescription, each paste limit 1 yuan; The annual limit of outpatient compensation for town-level cooperative medical care is 5000 yuan [2].

be hospitalized

Reimbursement scope:

Medical expenses: auxiliary examination: the examination expenses of electrocardiogram, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and MRI are limited to 200 yuan;

Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 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.

Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

serious illness

All inpatients who participate in cooperative medical care, whose medical expenses exceed 5,000 yuan at one time or for the whole year, should be compensated by stages, that is, 500 1- 10000 yuan is 65%, and1-18000 yuan is 70%.

The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 25 The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.