What is the reimbursement ratio of Dongguan social security gold card hospitalization?

Different hospitalization qifubiaozhun will lead to different reimbursement rates. 500 yuan, the first-class hospital in the city, 800 yuan, the second-class hospital, the third-class hospital 1.300 yuan, and the hospitals outside the city are calculated according to the minimum payment standard of 1.000-2.000 yuan. If you want to reimburse hospitalization expenses, no matter where you see a doctor, you must first meet the basic qifubiaozhun.

Payment proportion

The reimbursement rate of medical insurance hospitalization in Dongguan depends on the hospitalization expenses. Less than 50 thousand yuan, according to the proportion of 85%-95% reimbursement. The medical expenses of 50-65438+ 10,000 yuan shall be reimbursed by 60-75%, and the medical expenses of10-150,000 yuan shall be reimbursed by 45-55%. Moreover, different levels of hospitals outside the city have different reimbursement rates, generally ranging from 30% to 80%, depending on the specific expenses and hospital level.

ceiling

Although more expenses can be reimbursed according to the proportion of hospitalization reimbursement for medical insurance in Dongguan, there will still be certain restrictions on medical insurance reimbursement. For those who have been insured for less than 6 months, the maximum compensation limit is 1 1,000 yuan, less than 1 year is 20,000 yuan, and less than 2 years is 50,000 yuan. And the payment is over two years and less than three years, the limit is 654.38+10,000 yuan. Only by paying medical insurance in Dongguan for more than 3 years can the limit reach 200,000 yuan.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.