Proportion of reimbursement for medical treatment in Xiamen medical insurance in different places

First, the proportion of medical insurance reimbursement in different places in Xiamen

There is an upper limit, and the specific reimbursement ratio of medical insurance in different places is as follows:

1, 88% of the threshold fee above 3,000 yuan;

2, 3000-5000 yuan is 90%;

3, 5000- 10000 yuan is 92%;

4. 10000 yuan is 95% of the maximum payment limit;

5. Among them, 80% are Class B drugs, 70% are expensive drugs, and 70% are treated by special examination.

Medical insurance for medical treatment in different places:

1. You need to bring the insured's ID card and medical insurance card to the municipal medical insurance hall to get the registration form of the residents living in different places in the municipal medical insurance.

2, according to the provisions of the fill in and seal to the medical insurance institutions in different places.

3. Bring the completed application form back to the medical insurance institution of the insured place for review and confirmation.

4. When you are hospitalized, please call the municipal medical insurance center to register in time.

5. Within one month after discharge, bring hospitalization receipt, expense details, copy of case and copy of this form to reimburse hospitalization medical expenses.

6. Choosing a hospital for medical treatment must be a designated hospital for medical insurance in the place of residence.

7, inter-annual medical expenses must be settled annually.

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2. What is the proportion of medical insurance gap in Xiamen in the first half of the year?

Legal analysis: the reimbursement ratio of social security and medical insurance is as follows: 1. Proportion of hospitalization reimbursement: 1. First-class hospitals, which exceed the Qifubiaozhun to the highest payment limit, can be reimbursed 90%; 2, secondary hospitals, Qifubiaozhun above to 1 ten thousand yuan can compensate 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%; 3, tertiary hospitals, more than Qifubiaozhun to 5000 yuan can be compensated by 80%; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

4 retirees can increase 5% on the basis of the above reimbursement ratio.

Second, the deductible line for hospitalization reimbursement: 1, 200 yuan, a first-class hospital; 2, the secondary hospital Wu Bai yuan; 3. 800 yuan, a tertiary hospital; 4, malignant tumor patients, in a medical year for many times due to radiotherapy and chemotherapy medical expenses, only calculate a deductible.

III. Proportion of reimbursement for outpatient chronic diseases: Outpatient chronic diseases are divided into Class A chronic diseases and Class B chronic diseases.

1. The outpatient medical expenses that meet the requirements due to illness of patients with chronic diseases of Class A shall be compensated by the overall fund by 85%.

Outpatient hemodialysis expenses, peritoneal dialysis expenses and cyclosporine A expenses for patients with chronic renal failure (renal failure) after organ transplantation shall be reimbursed on the above basis, and then increased by 10%.

2. B Chronic disease deductible standard: 300 yuan.

The outpatient medical expenses incurred by patients with chronic diseases of Class B due to illness can be reimbursed by 80% for the part exceeding the deductible standard, and shall not be higher than the maximum payment limit for chronic diseases within a medical year (or within the validity period).

3. The insured can identify two chronic diseases of Class B at the same time, and calculate the deductible of each disease according to the management of the first two diseases.

The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure.

The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

Legal basis: According to the provisions of the Social Insurance Law, the following medical expenses are not included in the payment scope of the medical insurance fund for urban and rural residents: 1, and should be paid from the industrial injury insurance fund; 2, should be borne by a third person; 3, should be borne by public health; 4. Go abroad for medical treatment.

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

Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.

Fifth people's governments at or above the county level shall incorporate social insurance into the national economic and social development plan.

The state raises social insurance funds through multiple channels.

People's governments at or above the county level shall give necessary financial support to social insurance.

The state supports social insurance through preferential tax policies.