What is the proportion of medical insurance reimbursement in Hangzhou?

The proportion of medical insurance reimbursement is 88% for on-the-job reimbursement in community hospitals and 92% for retirement reimbursement.

The specific criteria are as follows:

Outpatient reimbursement standard:

In the fiscal year of 1, the general outpatient medical expenses incurred by employees in line with the scope of medical insurance expenses shall be paid through the fund of the current year in the personal account, and the insufficient part of the personal account shall be borne by the individual as the standard outpatient qifubiaozhun expenses, and then reimbursed according to the proportion of medical insurance reimbursement in Hangzhou. The minimum threshold for community and tertiary hospitals is 1 1,000 yuan, and the retirees are 300 yuan. Third-level hospitals bear 24% for individuals, 20% for other hospitals, 14% for communities, and the rest is borne by the medical insurance pooling fund.

Hospitalization reimbursement standard:

1, hospitalization also has a certain deductible standard, but it should be noted that if there are more than two bamboo gardens in a settlement year, the deductible standard is calculated according to the standard of the highest level hospital. According to the regulations, the deductible line of tertiary hospitals is 800 yuan, other hospitals are 500 yuan, and community hospitals are 300 yuan. In tertiary hospitals, 82% of employees and 86% of retirees are reimbursed within 40,000 yuan. Other hospitals reimburse 84% for on-the-job expenses and 88% for retirement expenses. In-service reimbursement of community hospitals is 88%, and retirement reimbursement is 92%;

2. The reimbursement rate of Hangzhou Medical Insurance for employees in tertiary hospitals is 88% for 400,000-400,000 yuan and 92% for retired employees. Other hospitals reimburse 90% for on-the-job expenses and 94% for retirement expenses. In-service reimbursement of community hospitals is 92%, and retirement reimbursement is 96%. Therefore, it is still necessary to pay attention to the level and specific expenses of the hospital, and the part that meets the standards can be reimbursed according to regulations.

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 medical insurance reimbursement in different regions is different. Urban and rural residents living in different places for a long time, urban and rural residents over 60 years of age and women over 55 years of age, urban and rural residents working in different places and their accompanying children have registered for medical treatment in different places. The deductible standards for hospitalization in the registered places are 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan respectively, and the reimbursement ratio is implemented by local designated hospitals.

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.