Overall reimbursement ratio of Wuxi medical insurance

Overall reimbursement ratio of Wuxi medical insurance:

1, outpatient co-ordination

(1) For those who seek medical treatment in community health service institutions, the proportion of outpatient co-ordination fund payment for on-the-job and retirees is 80% and 90% respectively;

(2) In primary and secondary medical institutions, the proportion of in-service and retirees' outpatient co-ordination fund payment is 75% and 85% respectively;

(3) In tertiary medical institutions, the proportion of in-service and retirees' outpatient pooling funds is 60% and 70% respectively;

2, outpatient special diseases

(1) Before the founding of the People's Republic of China, 97% of employees, 98.5% of retirees and 99. 1% of old workers, and the proportion of residents' medical insurance paid for the hospitalization fund of community medical institutions;

(2) The insured person who has a designated institution for the first visit, and the insured person who has no designated institution for referral for the first visit, the medical expenses incurred by other medical institutions shall be paid in advance by 20%, and then reimbursed according to the prescribed proportion;

3. Hospitalization

(1) 97% and 98% of medical institutions (including nursing homes) at the first level and below;

(2) The secondary medical institutions are 95% and 97% respectively;

(3) 90% and 95% of tertiary medical institutions respectively.

Medical insurance coverage:

1, reimbursement of basic medical insurance drugs: our country now divides drugs into three categories: A, B and C, of which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;

2. Reimbursement of basic medical service facilities: this reimbursement scope mainly refers to bed fees, first-aid bed fees, medical treatment fees, etc. Expenses incurred by the insured in the process of medical treatment and nursing in designated medical insurance institutions;

3. Reimbursement of basic medical insurance diagnosis and treatment items: it must be a safe and effective diagnosis and treatment item, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.

To sum up, the medical insurance pooling fund is to put the medical insurance contributions of all units into a public fund part, and not to record them in personal accounts.

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.