Proportion of medical insurance reimbursement in Foshan City

Medical personnel from different places, such as Foshan referral, are hospitalized in designated hospitals in different places. The hospitalization deductible standard is 2700 yuan for urban and rural residents, students, children and college students 1400 yuan, and the reimbursement rate is 60%.

Medical insurance reimbursement standard:

1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;

2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;

3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.

Reimbursement standard of medical insurance for chronic diseases:

1. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The expenses of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure were further increased by 10 percentage point.

2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and the maximum payment limit for chronic diseases shall not be exceeded within one medical year (or validity period);

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the two diseases identified first, and calculate the deductible for each disease separately. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

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 reimbursement rate of medical insurance in Foshan is 95% for hospitalization, 90% for secondary hospitals, 85% for tertiary hospitals, 85% for general outpatient primary hospitals, 80% for secondary hospitals and 75% for tertiary hospitals, with an annual limit of 4,500-5,500 yuan. The proportion of medical insurance reimbursement is different in different regions. Urban and rural residents who have lived in different places for a long time, urban and rural residents who have reached the age of 60 and women who have reached the age of 55, urban and rural residents who work in different places, and students and children who live with them shall be registered for medical treatment in different places. The deductible standard for hospitalization in the registered place is 400 yuan, a first-class hospital and 800 yuan, 2000 yuan, and the reimbursement ratio is implemented in the designated hospital of Baoji City.

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.