Shijiazhuang city health insurance hospitalization reimbursement ratio is how much?

A, resident health insurance card reimbursement ratio

1, resident insurance hospital in the starting standard above the hospitalization medical expenses in line with the provisions of the health insurance fund to pay the proportion of: in the community health centers, hospitalization in the first level of health care institutions, the proportion of 60%; hospitalization in the second level of health care institutions, the proportion of 50%; hospitalization in the third level of health care institutions, the proportion of 40%.

2. Starting payment standard: It refers to a certain amount of medical expenses that should be borne by the individual before being paid by the medical insurance fund according to the regulations. Only medical expenses above the starting standard can be paid by the medical insurance fund in accordance with the prescribed proportion.

3. The starting standard for hospitalization is 200 yuan for community health centers and first-level medical institutions, 400 yuan for second-level medical institutions, and 800 yuan for third-level medical institutions. The starting payment standard for hospitalization in Huimin Hospital for low-income people is 100 yuan. Residents who are incapable of working, have no fixed income, and have no fixed breadwinner or supporter are not subject to the starting payment standard for hospitalization in Huimin Hospital.

The reimbursement rate of employee health insurance card

1. Outpatient and emergency medical expenses: the part of the accumulated medical expenses exceeding 2,000 yuan in the year (January 1~December 31) of an active employee which are covered by the basic medical insurance.

2. Settlement ratio: 50% reimbursement for the part above 2000 RMB for the dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to the dispatched staff is 20,000 RMB cumulatively in a year.

3. Resident insurance outpatient clinic - In an insurance year, the resident medical insurance fund pays 30% and the individual pays 70% of the general outpatient expenses incurred by the insured residents in the outpatient designated medical institutions up to and including 100 yuan; the individual pays for the expenses of more than 100 yuan.

Expanded Information

Shijiazhuang City, the basic medical insurance policy interpretation:

1, Q: Employee health insurance general outpatient reimbursement of outpatient coordination how much?

A: general outpatient policy is: the starting standard level and the following medical institutions 700 yuan, the second level of medical institutions 1,000 yuan, three medical institutions 1500 yuan; reimbursement ratio of 80% of the first level of medical institutions and the following medical institutions, the second level of medical institutions 70%, 60% of the third level of medical institutions; the annual reimbursement limit of 1,500 yuan of active employees, retirees for 2,500 yuan. All counties (cities) can refer to the implementation.

2. Q: What is the starting standard and reimbursement rate for chronic diseases of employees?

A: Chronic diseases and common diseases are managed separately, increasing the treatment of chronic diseases. The starting line is 200 RMB without distinguishing the level of medical institutions, and the reimbursement rate is 90% for first-class and following medical institutions, 85% for second-class medical institutions, and 80% for third-class medical institutions.

3, Q: Employee health insurance chronic diseases and annual reimbursement limit?

A: chronic disease types increased from 15 to 30, and divided into two categories, one for the annual reimbursement limit of 2,000 yuan, the specific types of disease: 1 hypertension (Ⅲ high risk and above); 2 heart disease; 3 pulmonary heart disease; 4 chronic obstructive pulmonary disease; 5 angina pectoris; 6 myocardial infarction; 7 chronic atrial fibrillation; 8 a variety of chronic heart failure; 9 cerebrovascular disease sequelae (with serious) dysfunction); 10 chronic hepatitis; 11 chronic nephritis; 12 nephrotic syndrome; 13 rheumatoid arthritis (with severe limb dysfunction or severe organ damage); 14 epilepsy; 15 active tuberculosis; 16 osteonecrosis of the femoral head; 17 primary aldosteronism; and 18 leukopenia and granulocytopenia.

The other category has an annual reimbursement limit of 3,000 yuan for the following diseases: 1 diabetes mellitus (combined with severe complications); 2 chronic renal failure (not to the extent of dialysis); 3 mental disorders; 4 systemic lupus erythematosus; 5 cirrhosis of the liver; 6 Parkinson's disease; 7 myasthenia gravis; 8 myelodysplastic syndrome; 9 systemic sclerosis; 10 thrombocytopenic purpura; 11 chronic osteomyelitis; 12 motor neuron disease.

If you have two or more chronic diseases, the starting line is not cumulative and the annual payment limit is cumulative, with a maximum annual payment limit of $5,000.

4, Q: employee health insurance large medical insurance adjusted to major medical insurance, how to reimbursement?

A: (a) the starting standard. 2017 annual starting standard for the insured employees individual out-of-pocket medical expenses 20000 yuan. (ii) Reimbursement ratio. Above the starting standard to 10000 yuan (excluding the starting line) part of the reimbursement of 50%, above 10000 yuan to 20000 yuan part of the reimbursement of 60%, above 20000 yuan to 30000 yuan part of the reimbursement of 70%; 30000 yuan to 40000 yuan part of the reimbursement of 80%; 40000 yuan to the maximum payment limit of part of the reimbursement of 90%. (iii) Reimbursement limit. In a billing year, the annual maximum limit of reimbursement for employees' major medical insurance is 400,000 yuan, plus the annual reimbursement limit of 250,000 yuan for the basic medical insurance fund,*** totaling 650,000 yuan.

Social security network: 2018 Shijiazhuang city health insurance reimbursement ratio

Shijiazhuang people's government official website: Shijiazhuang city basic medical insurance policy interpretation