Weifang medical insurance reimbursement ratio 2023

Proportion of medical insurance reimbursement in Weifang in 2023:

1, reimbursement ratio of employee medical insurance hospitalization:

(1) 85% of hospitalization expenses are between 1300 yuan-30,000 yuan;

(2) The reimbursement rate between 30,000 yuan and 40,000 yuan is 90%;

(3) The reimbursement rate between 40,000 yuan and10,000 yuan is 95%;

(4 4) 10/00000 yuan to 300000 yuan reimbursement ratio is 85%;

2, the proportion of residents' medical insurance reimbursement:

(1) The reimbursement rate of first-class hospitals is 65%;

(2) 80% of the second-level hospitals are reimbursed for more than 6,000 yuan.

Medical insurance reimbursement process:

1. The applicant brings relevant materials to the social security center to apply;

2. The staff will review the submitted materials;

3, after the examination and approval for employee medical insurance reimbursement.

Bring all the above information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it will be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.

Medical insurance reimbursement materials:

1, ID card;

2. Social security card;

3. Leave invoices for hospitalization expenses;

4, the original hospitalization expenses summary list;

5. The first page of medical records;

6. Discharge summary;

7. Cost summary table;

8. Expense receipt;

9, door (emergency) medical records and inspection reports (emergency);

10, pathological examination report;

1 1, operation record;

12, long-term and temporary orders;

13, other required information.

To sum up, the three most commonly used types of medical insurance reimbursement are general drug purchase, outpatient service and hospitalization. Different categories have different reimbursement rates, methods and procedures.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.