What is the proportion of hospitalization reimbursement in Zibo in 2023?

Zibo social security card reimbursement scope, Zibo hospital reimbursement ratio I compiled. Social security cards have a wide range of functions. Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Go through the formalities of job registration and unemployment registration; Apply for unemployment insurance; Apply for employment training; Apply for labor ... I want to know more about the proportion of hospitalization reimbursement in Zibo. Let's take a look.

The scope of reimbursement for social security cards in Zibo and the proportion of reimbursement for medical treatment in hospitals in Zibo were compiled through collation.

Social security cards have a wide range of functions. Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Go through the formalities of job registration and unemployment registration; Apply for unemployment insurance; Apply for employment training; Apply for labor ability appraisal and enjoy work-related injury insurance benefits; Handling labor and social security affairs online.

First, the scope of reimbursement of social security cards in Zibo

The contribution ratio of medical insurance for enterprise employees is: 8% of the unit contribution base and 2% of the individual contribution base of employees. However, it should be reminded that the base of employee medical insurance payment in different provinces and cities is different. Taking Guangzhou as an example, the base of medical insurance payment for employees in Guangzhou is adjusted from 17424 yuan to 1856 1 yuan, and the lower limit is adjusted from 3485 yuan to 37 12 yuan. In addition, the payment base for flexible employees to participate in social medical insurance for employees is 60% of the average monthly salary of employees in this city last year, that is, 37 12 yuan.

It can be answered from the aspects of reimbursement ratio, general outpatient reimbursement, and serious illness reimbursement.

1. Reimbursement ratio of medical insurance for enterprise employees

(a) according to the first payment, in the implementation of the basic drug system, 80% of the hospitalization expenses are paid (90% of the basic drug payment), and 60% of the hospitalization expenses are paid in the implementation of the basic drug system; Secondary hospitals pay 58%; The tertiary hospital pays 45%.

(2) According to the second payment, the first-level hospital pays 85% (90% for essential drugs), the second-level hospital pays 70%, and the third-level hospital pays 60%.

(three) minor residents and special groups enjoy the medical insurance benefits of class II payment.

Qifubiaozhun for reimbursement of hospitalization medical expenses: 300 yuan, a first-class hospital, 500 yuan, a second-class hospital and 700 yuan, a third-class hospital. Malignant tumor patients who have been hospitalized for chemotherapy and radiotherapy for many times in a medical insurance year will only be deducted once.

2. The reimbursement ratio of outpatient medical insurance for enterprise employees.

Insured workers in designated community health service centers or township hospitals in accordance with the provisions of the outpatient medical expenses, paid by the general outpatient co-ordination fund according to the proportion of 50%. There is no deductible for the general outpatient expenses incurred by the insured workers in the basic medical institutions that implement the national basic drug system; In other primary medical institutions, the minimum payment standard was reduced from 40 yuan to 30 yuan. The reimbursement limit for the first-class general outpatient service was raised from 60 yuan to 80 yuan; The second payment was made in 200 yuan.

3. Serious illness medical insurance benefits

Degree, the deductible line of serious illness insurance is 1.2 million yuan, that is, after the reimbursement of basic medical insurance for residents, the part of the compliance medical expenses borne by individuals below 1.2 million yuan will not be compensated. 50% compensation will be given to the part where the compliance medical expenses borne by individuals exceed 1 .2000 yuan (including1.2000 yuan) and are less than110000 yuan; 65.438+10,000 yuan (including 6.5438+10,000 yuan) and 60% compensation for the part less than 200,000 yuan; More than 200,000 yuan (including 200,000 yuan) will be compensated by 65%. In a medical year, the maximum payment for serious illness insurance is 300,000 yuan per person. This standard will still be implemented before the relevant departments introduce a new serious illness insurance policy.

The individual payment standard of medical insurance for residents in our city is uniformly adjusted to per person 160 yuan. According to the change of financing level, according to the principle of "fixed expenditure based on income, balance of payments and slight balance".

Second, the proportion of hospitalization reimbursement

Residents' medical insurance personal payment is implemented in two grades. In the formulation of hospitalization reimbursement policy, it also embodies the principle of high-level payment and high-level guarantee. The proportion of hospitalization reimbursement in secondary and tertiary hospitals in the city is set to two files. The individual payment standard of residents' medical insurance is unified into one file, so the setting of hospitalization reimbursement ratio has also been adjusted appropriately.

1. First-class hospitals (such as township hospitals and community health service centers) will be fully reimbursed in 200 yuan above the deductible line;

2. The Qifubiaozhun for secondary hospitals is in 500 yuan, and the reimbursement rate is 75%;

3, tertiary hospitals 1000 yuan, the reimbursement rate is 50%.

The insured residents were reimbursed for hospital delivery, and the cesarean section cost 2,000 yuan, and the delivery was natural in 500 yuan. If there are complications or complications, they will be paid according to the normal hospitalization ratio.

The maximum payment limit for hospitalization of residents' basic medical insurance is 6.5438+0.5 million yuan.

Transferred to the city for medical treatment and hospitalization, the insured residents need to bear a certain proportion, and transferred to the medical institutions outside the city for hospitalization, according to the unified provisions of the province; When transferring to a non-networked medical institution outside the city for hospitalization, the medical expenses incurred within the scope of the policy shall be paid 10% by the individuals who have gone through the referral procedures according to the regulations, and 20% by the individuals who have not gone through the referral procedures, and then paid according to the hospitalization qifubiaozhun and reimbursement ratio of the tertiary hospitals in the city.

Prompt: The insured residents will be reimbursed for delivery in hospital, and the cesarean section will cost 2,000 yuan, and they will give birth to 500 yuan naturally. Those with complications will be paid according to the normal hospitalization ratio.