Chengdu hospitalization medical insurance how to reimbursement rate is how much

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Chengdu medical insurance hospitalization reimbursement guide, 2017 Chengdu flexible employment personnel medical insurance reimbursement ratio, 2017 Chengdu medical insurance reimbursement scope, Chengdu medical insurance tertiary hospital hospitalization reimbursement ratio.

Chengdu reporters learned from the Municipal Bureau of Human Resources and Social Security, from July 1 this year, Chengdu urban and rural residents of basic medical insurance hospitalization reimbursement ratio began to implement the latest standards, an average increase of 4%, the highest increase of 10%. At the same time, the threshold fee for hospitalization in township health centers has also been raised from 50 yuan to 100 yuan, while the threshold fee for other levels of hospitals remains unchanged. Currently, Chengdu has implemented basic medical insurance reimbursement for urban and rural residents according to the new standard.

The Chengdu reporter inquired that, among them, the reimbursement for those who pay contributions according to the second class, students and children hospitalized in second-class hospitals has increased the most, from 65% to 75%. The reimbursement rate for tertiary hospitals remained unchanged.

Li Chusheng, director of the Urban and Rural Medical and Workers' Compensation Insurance Division of the Municipal Human Resources and Social Security Bureau, said that after the adjustment, the starting standard for urban and rural residents' basic medical insurance hospitalization is 100 yuan for township health centers, community health centers and first-tier hospitals, 200 yuan for second-tier hospitals and 500 yuan for third-tier hospitals.

Adjusted reimbursement rates

Reimbursement rates according to the second tier of contributions: township health centers, community health centers and first-level hospitals 92 percent, first-level hospitals 85 percent, second-level hospitals 75 percent and third-level hospitals 50 percent.

Reimbursement rate according to the third tier of payment: 92% for township health centers and community health centers, 87% for first-level hospitals, 82% for second-level hospitals and 65% for third-level hospitals.

Reimbursement rates for student children: 92% for township health centers and community health centers, 85% for first-tier hospitals, 75% for second-tier hospitals, and 50% for third-tier hospitals.

Reimbursement rates for university students: 92 percent for township health centers and community health centers, 85 percent for first-level hospitals, 75 percent for second-level hospitals and 50 percent for third-level hospitals.

Medicare reimbursement process, employee health insurance reimbursement rate latest news

In order to standardize the scope of use of health insurance funds, to prevent the health insurance fund is abused, theft, Chengdu Social Security Bureau of health insurance reimbursement rate and payment standards for detailed provisions. In order to let the general public understand the Chengdu medical insurance reimbursement ratio, fast for reimbursement procedures, our editorial Chengdu medical insurance reimbursement ratio is summarized.

Chengdu medical insurance reimbursement regulations

Chengdu residents medical insurance reimbursement standards

Type of insurance hospital level starting standard (yuan) reimbursement ratio (%)

First class second class third class students and children

Residents medical insurance first-class hospitals/community health service centers 10060808580

Second-class hospitals 20055658065

Tertiary hospitals 50035506550

Township health centers 5065909090

Remarks: 1. The starting standard for out-of-town referrals is 1,000 yuan.

2. The outpatient payment ratio is 60%, with a cumulative outpatient limit of 200 yuan in a natural year.

Chengdu Employee Medical Insurance Hospitalization Reimbursement Ratio

Insurance Type Hospital Level Starting Line (RMB) Reimbursement Ratio (%) Remarks

Employee Medical Insurance Level 1 Hospital 20092 On the basis of the above, 2% for those who have reached the age of 50, 4% for those who have reached the age of 60, 6% for those who have reached the age of 70, 8% for those who have reached the age of 80, and 10% for those who have reached the age of 90. 10% for those who have reached the age of 90. The percentage of reimbursement of medical expenses after the increase according to age shall not exceed 100%.

Second-level hospitals 40090

Third-level hospitals 80085

Township health centers

Community service centers 16095

Chengdu special outpatient reimbursement starting line standard:

1, urban workers basic medical insurance participants: 200 yuan for first-level hospitals, 400 yuan for second-level hospitals, third-level hospitals 800 yuan, community health service centers (including township health centers) 160 yuan.

2. Basic medical insurance for urban and rural residents: RMB 100 for first-level hospitals, RMB 200 for second-level hospitals, RMB 500 for third-level hospitals, and RMB 100 for community health service centers (including township health centers).

3. In a natural year, the first category of diseases is not counted as the starting standard; the second and third categories of diseases are counted as the starting standard twice and are not reduced one by one; the fourth category of diseases is counted as the starting standard once.

4, urban workers' basic medical insurance participants aged 100 years or older are not counted as the starting standard.

Response to the latest inquiries: What is the reimbursement rate for hospitalization under medical insurance for non-Chengdu rural residents who are enrolled in employee social security in Chengdu? Is there any difference with Chengdu locals?

Response: The urban workers' basic medical insurance hospitalization medical treatment has nothing to do with the household registration of the insured. If a participant's one-time hospitalization medical expenses incurred in a designated medical institution are above the starting standard of the integrated fund, after deducting the first out-of-pocket expenses of the individual, the integrated fund will pay the proportion according to the level of the hospital: 85% for third-level hospitals, 90% for second-level hospitals, 92% for first-level hospitals, and 95% for community health centers that have signed an agreement on inpatient medical services with the medical insurance institution. On top of that, 2% is added for those who have reached the age of 50, 4% for those who have reached the age of 60, 6% for those who have reached the age of 70, 8% for those who have reached the age of 80, and 10% for those who have reached the age of 90. The percentage of reimbursement of medical expenses after the increase according to age shall not exceed 100%.

Do urban workers' medical insurance and urban and rural residents' medical insurance in Chengdu city have the same reimbursement rate? Is the starting line the same?

Response: The reimbursement ratio is different between Chengdu Urban Workers' Medical Insurance and Urban and Rural Residents' Medical Insurance, and the starting payment is also different.

What is the reimbursement rate for Chengdu students' and children's medical insurance? What is the telephone number for inquiries?

Response: The reimbursement rate of Chengdu students' and children's medical insurance is 90% for township health centers, 80% for community health service centers and first-class hospitals, 65% for second-class hospitals, and 50% for third-class hospitals. For more information, please contact 028-123333.

Medical insurance is like a huge pool of money, some people keep putting money into it, and some people also take money from it. As long as there is a balance in the pool, the insured will be able to alleviate some of the financial pressure when they fall ill.

I. What is the standard for urban and rural residents' medical insurance contributions in 2017?

(A) Basic medical insurance

Adult residents' individual contribution standard: 160 yuan/person-year, 320 yuan/person-year two grades.

Students, children (including college students) individual contribution standard: 150 yuan / person - year (including major medical care mutual supplemental insurance and serious illness medical insurance).

(2) Medical Mutual Aid Supplementary Insurance for Major Diseases

The contribution standard for Medical Mutual Aid Supplementary Insurance for Major Diseases is: RMB 460/person/year and RMB 230/person/year for two levels.

Payment time: from September 1, 2016 to December 20, 2016, after the deadline.

Medical treatment entitlement time: from 00:00 on January 1, 2017 to 24:00 on December 31, 2017 (from 00:00 on September 1, 2016 to 24:00 on August 31, 2017 for college students).

There is a 6-month waiting period for first-time enrollment in the supplemental insurance for mutual assistance in major medical care (except for students and children).

Two: What are the medical benefits of urban and rural residents' medical insurance?

(1) Hospitalization treatment

The hospitalization medical expenses incurred by insured persons that meet the scope of reimbursement can be settled by directly swiping the social insurance card at designated medical institutions. The details are as follows:

Chengdu City 2017 urban and rural residents medical insurance hospitalization reimbursement policy list

Projects

Types of insurance

Basic medical insurance

Urban and rural major diseases

Major medical illnesses medical mutual assistance supplemental insurance

Severely serious illnesses

Medicare

The starting line

The starting line is as follows

100 yuan for township health centers, community health centers and first-level hospitals, 200 yuan for second-level hospitals, 500 yuan for third-level hospitals, and 1,000 yuan for out-of-town referrals.

17,690 yuan

In line with basic medical insurance

No starting line

Cap line

200,800 yuan

No cap line

400,000 yuan for the 460 yuan bracket

200,000 yuan for the 230 yuan bracket

150,000 yuan

(treatment) year)

Reporting

Spending

Ratio

Example

Adult high-grade

Rural township health centers and community health centers 92%, first-level hospitals 87%; second-level hospitals

82%; tertiary hospitals 65%.

Single or multiple hospitalizations need to be personally responsible for the amount of the total number of compliant medical expenses over the starting standard, 0-5000 yuan part of the reimbursement rate of 50%; more than 5000 yuan - 20000 yuan part of the reimbursement rate of 60%; more than 20000 yuan - 50000 yuan part of the reimbursement rate of 76%; 50000 yuan or more part of the reimbursement rate of

Approximation ratio of 91%.

Basic

The remaining part of the reimbursement after the reimbursement within the basic medical insurance policy is reimbursed proportionally in graded segments.

For the $460 bracket, the ratio of reimbursement for the remaining portion of 0-10,000 yuan

is 77 percent; the ratio of reimbursement for the remaining portion of more than 10,000-30,000 yuan is 80 percent; the ratio of reimbursement for the remaining portion of more than 30,000-50,000 yuan is 85 percent; and the ratio of reimbursement for the remaining portion of more than 50,000 yuan is 90 percent.

For the $230 bracket, the reimbursement rate for the remaining portion of $0-$10,000

is 38.5 percent; the reimbursement rate for the remaining portion of more than $10,000-$30,000 is 40 percent; the reimbursement rate for the remaining portion of more than $30,000-$50,000 is 42.5 percent; and the reimbursement rate for the remaining portion of more than $50,000 is 60 percent.

Medical expenses eligible for payment under the Medical Insurance Drug Catalog for Serious Diseases will be paid by the funds of the Supplementary Medical Mutual Aid Insurance for Major Diseases at a rate of 70%.

Adult low-grade

92% for township health centers and community health centers, 85% for first-level hospitals; 75% for second-level hospitals

; and 50% for third-level hospitals.

Students

Children's grade

Rural township health centers and community health service centers 92%, first-level hospitals 85%; second-level hospitals

75%; third-level hospitals 55%.

Reimbursement sequence

Basic medical insurance first, then urban and rural residents' major disease insurance, then major disease medical mutual aid supplemental insurance, the total amount of reimbursement and civil assistance costs

must not exceed the actual hospitalization medical expenses incurred.

(2) Outpatient Treatment

1. General Outpatient Treatment: The reimbursement rate for outpatient medical expenses incurred by insured persons at outpatient coordinating designated medical institutions that meet the scope of reimbursement is 60%, with a cumulative total of up to 200 yuan in a natural year.

2. Outpatient Special Diseases: medical expenses incurred by the insured that are eligible for reimbursement for outpatient special diseases will be reimbursed in accordance with the relevant regulations.

3. Canine Injury Outpatient Clinic: outpatient medical expenses incurred in wound treatment and human rabies vaccine injection (including vaccine fee) in canine injury disposal medical institutions shall be reimbursed not more than RMB 200 per person.

(3) Maternity Benefits

Participants in basic medical insurance for urban and rural residents can enjoy maternity insurance benefits for urban and rural residents in accordance with the regulations without having to pay separate maternity insurance premiums. Maternity insurance participants in line with the family planning policy, outpatient routine checkups during pregnancy at a fixed amount of 400 yuan per person; in the first level and below the normal birth of 1000 yuan per person, cesarean section of 1400 yuan per person; in the second level and above the normal birth of 1200 yuan per person, cesarean section of 1600 yuan per person.

Newborn care expenses incurred by insured persons during labor and delivery are paid at a flat rate of 100 yuan per newborn. Reimbursement range