What is the reimbursement ratio of Wuxi medical insurance hospitalization?

Medical insurance is one of the basic social security policies in China, which provides basic protection for the health of China residents. I hope it will help everyone.

1. What is the reimbursement rate of hospitalization medical insurance?

Proportion of reimbursement for rural hospitalization medical insurance:

Outpatient service

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 compensation limit for rural cooperative medical clinics is 5000 yuan.

be hospitalized

Reimbursement scope:

Medical expenses: auxiliary examination: the examination expenses of electrocardiogram, X-ray fluoroscopy, photography, laboratory test, physiotherapy, acupuncture, CT and magnetic resonance 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.

exonerate

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 provisions of public medical care, and medical expenses that do not conform to family planning; Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, escort fee, nutrition fee, blood transfusion fee (except for family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ; Within the scope of reimbursement, beyond the limit.

Proportion of reimbursement for urban hospitalization medical insurance:

Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.

Students, children

In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

At least 70 years old and above.

In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

Other urban residents

In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Second, the scope of medical insurance reimbursement

First of all, the difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level.

Generally, Class A drugs can enjoy full coverage, while Class C drugs need to bear all the expenses, while Class B drugs will be charged 80% and bear 20% of the expenses.

A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.

Secondly, medical insurance also has exclusions, and the following ten items are not within the scope of medical insurance reimbursement.

1. Special medical expenses include organ and tissue transplantation due to illness, organ and tissue purchase and use of anti-rejection drugs and immunomodulatory drugs beyond the scope of medical insurance reimbursement for Zhenjiang employees;

2. Work-related injuries and occupational diseases;

3. Female workers give birth;

4. Rogue fights;

5. Injuries caused by alcoholism;

6. Traffic accidents;

7. Others intentionally hurt;

8. Medical malpractice;

9. Beauty and health examination;

10, other expenses not paid by the social medical insurance fund.

The third is the reimbursement policy for medical expenses of insured employees who travel, visit relatives and live in other places for a long time.

1. The medical expenses incurred by the insured employees on business trips or visiting relatives in other places will only be reimbursed for emergency expenses in other places that meet the requirements of medical insurance, and all expenses incurred for hospitalization for non-emergency reasons will not be reimbursed.

2, the insured workers living in the field for more than 6 months, according to the nature of long-term living in the field of medical expenses.

3, long-term residents should provide proof by the unit, determine the secondary designated hospitals (should be designated medical institutions for local medical insurance), and timely handle the "Zhenjiang long-term residents medical expenses reimbursement card".

4. Employees who live in other places for a long time must adhere to the principle of economy and prescribe drugs in a limited amount according to regulations (the acute dosage is within 3 days, the chronic dosage is within 10 days, and the dosage of tuberculosis, hypertension and diabetes can be extended to 30 days). Those who exceed the above standards will not be reimbursed for medicine.

5, long-term residence in the field of referral, need to be signed by the local designated hospitals, step by step according to the principle of territoriality referral, referral hospital for medical insurance for employees in our city to determine the special hospital. The individual pays 65438+ 00% of the total expenses first, and then reimburses the expenses according to the medical insurance regulations. Other hospitals and individuals pay 20% of the total expenses first, and then reimburse medical expenses according to medical insurance regulations.

3. How long does it take for medical insurance reimbursement to arrive?

Generally, local medical reimbursement takes 15 working days, and off-site medical reimbursement generally arrives within 30 working days.

When reimbursing medical expenses, I need to provide my ID card, social security card (or medical insurance card), hospitalization medical records, medical expense list, expense invoice and bank card account number. After the medical insurance subsidy is audited by the medical insurance fund center, it is transferred to the bank card account. Social security cards (citizen cards) or medical insurance cards with bank accounts do not need to provide bank cards.

The above is the whole content of this paper, from which we can know what is the proportion of hospitalization medical insurance reimbursement, the scope of medical insurance reimbursement, and how long it takes for medical insurance reimbursement to arrive. They are online 24 hours a day and can answer your legal questions at any time.

Legal objectivity:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, standards of medical service facilities and medical expenses for emergency rescue, and shall be paid from the basic medical insurance fund in accordance with state regulations. "People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.