Proportion of medical insurance reimbursement in Chengdu

Outpatient service: reimbursement ratio:1above 800 yuan, hospitalization 70%, community 90%, top line 20,000 yuan. Hospitalization: 90% of the first-class hospital standard, 87% of the second-class hospital standard, 85% of the third-class hospital standard, and the total hospitalization reimbursement is 300,000 yuan.

1. What is the proportion of medical insurance reimbursement in Chengdu?

Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. The following is an explanation of the proportion of medical insurance for employees in Chengdu.

After receiving medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed, and the reimbursement rate is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.

No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 700 yuan can reimburse 50%, that is, 350 yuan.

Two, non Chengdu rural household registration personnel in Chengdu to participate in employee social security. What is the reimbursement rate of medical insurance hospitalization?

The basic medical insurance for urban workers has nothing to do with the insured's household registration. One-time hospitalization expenses incurred by the insured in the designated medical institutions, the amount of which is above the Qifubiaozhun of the overall fund, will be paid by the overall fund according to the proportion of hospital level after deducting the expenses paid by the individual: 85% of tertiary hospitals, 90% of secondary hospitals, 92% of primary hospitals and 95% of community health service centers that have signed hospitalization service agreements with medical insurance institutions. On this basis, the population over 50 years old will increase by 2%, over 60 years old by 4%, over 70 years old by 6%, over 80 years old by 8%, and over 90 years old by 10%. According to the reimbursement ratio of medical expenses after aging, it shall not exceed 100%.

3. What is the non-reimbursement scope of Chengdu medical insurance?

1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;

2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;

4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;

5, within the scope of reimbursement, beyond the limit.

4. What are the hospitalization medical insurance reimbursement procedures and precautions?

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution. When in hospital, the individual pays the deposit of medical expenses in advance, and pays more and less after discharge. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be used to go through the hospitalization formalities at the medical insurance management window the day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves.

2. The deductible line of the overall fund after the insured person is hospitalized: the deductible line varies from place to place, which is generally 10% of the average annual salary of employees in the whole city in the previous year. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3. If the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities with the approval of the medical insurance management department of the designated medical institution.

To sum up, Chengdu employees should choose designated hospitals for medical insurance when they go to the hospital for medical treatment, so the expenses for reimbursement will be more. The proportion of medical insurance reimbursement in Chengdu is between 50% and 80% according to the age of the applicant and the level of the hospital. The total reimbursement here is limited, of which the outpatient reimbursement shall not exceed 20 thousand yuan per year. Medical insurance is an important social security for employees, so we must learn to use it.

legal ground

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.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.