How to reimburse the employee health insurance in Sichuan province in 2017, what is the ratio

I. Outpatient and emergency expenses

1. For active employees, only medical expenses above 1800 yuan can be reimbursed after visiting outpatient and emergency clinics in hospitals, and the reimbursement rate is 50%.

2. Retirees under the age of 70 can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70 percent.

3. Retirees over 70 years of age can be reimbursed for expenses over $1,300 and the reimbursement rate is 80 percent.

Second, the cost of hospitalization

The maximum amount of payment from the Basic Medical Insurance Coordination Fund (for hospitalization expenses) is currently 70,000 yuan in a year.

1, hospitalization reimbursement rate is related to the level of the hospital in which the participant is staying, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or reimbursement of 85%;

2, 30,000 yuan to 40,000 yuan, the employee pays 10%, reimbursement of 90%;

3, the cost of more than 40,000 yuan to the part of the maximum payment limit , then 95 percent are reimbursed and the employee pays only 5 percent.

4. Retirees pay 60% of what active (that is, the aforementioned) employees pay individually, but anything below the threshold is paid by the individual.

Expanded information:

The standard of hospitalization reimbursement is related to the level of the hospital where the participant is staying, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, or 90% reimbursement; over 40,000 yuan to the part of the maximum payment limit , then 95 percent are reimbursed, with the employee paying only 5 percent.

And the individual retiree pays 60 percent of the active (that is, the aforementioned) employee's rate, but anything below the threshold is paid by the individual.

The diagnostic and therapeutic items that are not covered by the basic medical insurance for employees are mainly those that are not clinically necessary, those whose effects are uncertain, and those for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and others such as infertility treatments, and so on.

In accordance with the "National Basic Medical Insurance Diagnostic and Treatment Program Scope", the details are as follows:

(a) Service program category.

(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.

(2) visit fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, self-invited special nurses and other special medical services.

(2) The category of non-disease treatment programs.

(1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery;

(2) a variety of weight loss, fat, height projects;

(3) a variety of health checkups;

(4) a variety of preventive, health care treatment programs;

(5) a variety of medical consultation, medical appraisal.

Baidu Encyclopedia - Medical Insurance Reimbursement Rate