Guangzhou medical insurance hospitalization reimbursement ratio

The reimbursement rates for hospitalization in Guangzhou Medical Insurance Tier 3 are as follows:

1. 80% of the portion of the starting line from 800 yuan to 5,000 yuan;

2. 85% of the portion of the line from 5,000 yuan to 10,000 yuan;

3. 90% of the portion of the line from 10,000 yuan to the maximum payment limit;

4. Retirees. Retirees will be reimbursed at 5% higher than the above reimbursement rates.

Factors affecting the health insurance policy:

1. Policy changes: the reimbursement rate may change in different years or policy adjustments;

2. Hospital grade: the reimbursement rate may be different in a tertiary hospital compared with other grades of hospitals;

3. Drug directory: the reimbursement rate of the medicines inside and outside the health insurance drug directory is different;

4.

4. Disease restrictions: Some specific diseases may enjoy higher reimbursement rates;

5. Individual accounts: The amount of balance in an individual's health insurance account also affects the actual amount of reimbursement;

6. Regional variations: Differences in health insurance policies in different regions may result in different reimbursement rates.

In summary, the Guangzhou medical insurance tertiary hospitalization reimbursement policy stipulates that the starting line of 800 yuan to 5,000 yuan part of the reimbursement of 80%, 5,000 yuan to 10,000 yuan part of the reimbursement of 85%, 10,000 yuan or more to the maximum payment limit part of the reimbursement of 90%, and the retirees can enjoy an additional 5% reimbursement increase in these base rates.

Legal basis:

The People's Republic of China*** and the State Social Insurance Law

Article 23

Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employing unit and the employees in accordance with the state regulations*** together. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.

Article 24

The State establishes and improves the new rural cooperative medical care system. The administration of the new type of rural cooperative medical care shall be regulated by the State Council.

Article 26

The standards of treatment for basic medical insurance for employees, new rural cooperative medical insurance and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and salvages, shall be paid out of the basic medical insurance fund in accordance with the state regulations.