Proportion of hospitalization reimbursement in Nanjing

The proportion of reimbursement for hospitalization in Nanjing medical insurance is as follows:

The reimbursement rate of employees' medical insurance hospitalization is 85%, and the hospitalization expenses range from 1300 yuan to 30 thousand yuan; The reimbursement rate is 90% for 30,000-40,000 yuan, 95% for 4 4- 10/00,000 yuan and 85% for10-300,000 yuan. The reimbursement rate of residents' medical insurance is 65% in first-class hospitals, and 80% in second-class hospitals with more than 6000 yuan.

Medical insurance reimbursement standard:

1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;

2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio 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 the first-class hospital, and the reimbursement rate is 60%;

3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, the proportion of hospitalization medical insurance reimbursement in different regions is different. Urban and rural residents who have lived in different places for a long time, urban and rural residents over 60 years old and women over 55 years old, urban and rural residents who work in different places, and students and children who live with them have registered for medical treatment in different places. The deductible standard for hospitalization in the registered place is 400 yuan, and the first-class hospital is 800 yuan, RMB 2,000, and the reimbursement ratio is implemented according to the local designated hospital.

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.