Proportion of medical insurance reimbursement in Chengdu

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Chengdu medical insurance hospitalization reimbursement guide, 20 17 Chengdu medical insurance reimbursement ratio of flexible employees, 20 17 Chengdu medical insurance reimbursement scope, and Chengdu medical insurance reimbursement ratio of tertiary hospitals.

Chengdu reporter learned from the Municipal Bureau of Human Resources and Social Security that since July this year, the reimbursement rate of basic medical insurance for urban and rural residents in Chengdu has started to implement the latest standards, with an average increase of 4% and the highest increase of 10%. At the same time, the threshold for hospitalization in township hospitals was raised from 50 yuan to 100 yuan, while the threshold for other hospitals remained unchanged. At present, Chengdu has implemented the basic medical insurance reimbursement for urban and rural residents according to the new standards.

Chengdu reporter inquired that the reimbursement rate of secondary payers, students and children hospitalized in secondary hospitals increased the most, from 65% to 75%. The reimbursement rate of tertiary hospitals has not changed.

Li, director of the Urban and Rural Medical and Industrial Injury Insurance Division of the Municipal Human Resources and Social Security Bureau, introduced that after adjustment, the minimum threshold for hospitalization of basic medical insurance for urban and rural residents is 100 yuan for township hospitals, community health service centers and first-class hospitals, 200 yuan for second-class hospitals and 500 yuan for third-class hospitals.

Adjusted repayment ratio

The proportion of reimbursement by second payment: township hospitals and community health service centers 92%, first-class hospitals 85%, second-class hospitals 75% and third-class hospitals 50%.

The reimbursement rate of the third payment is 92% in township hospitals and community health service centers, 87% in first-class hospitals, 82% in second-class hospitals and 65% in third-class hospitals.

The reimbursement rate for students and children: 92% in township hospitals and community health service centers, 85% in first-class hospitals, 75% in second-class hospitals and 50% in third-class hospitals.

The reimbursement rate of college students: 92% in township hospitals and community health service centers, 85% in first-class hospitals, 75% in second-class hospitals and 50% in third-class hospitals.

The latest news of medical insurance reimbursement process and employee medical insurance reimbursement ratio

In order to standardize the use scope of medical insurance fund and prevent it from being abused and misappropriated, Chengdu Social Security Bureau has made detailed provisions on the proportion of medical insurance reimbursement and payment standards. In order to let the general public know the reimbursement rate of Chengdu medical insurance and handle the reimbursement procedures quickly, we have summarized the reimbursement rate of Chengdu medical insurance in Bian Xiao.

Provisions of Chengdu Municipality on Medical Insurance Reimbursement

Chengdu residents' medical insurance reimbursement standard

Hospital Grade Qifubiaozhun (Yuan) Reimbursement Ratio (%)

First, second and third grade students and children

Residents' medical insurance first-class hospital/community health service center 10060808580

Secondary hospital 20055658065

Tertiary hospital 50035506550

Township hospitals 5065909090

Remarks: 1. Threshold for referral in different places 1000 yuan.

2. The proportion of outpatient payment is 60%, and the cumulative outpatient limit in a natural year is 200 yuan.

Proportion of hospitalization reimbursement of medical insurance for employees in Chengdu

Hospital level deductible reimbursement ratio (%) Remarks (RMB)

On the basis of the above, in 2002, the age of 50, 60, 70, 6, 80 and 90 in the first-class hospitals with medical insurance for employees increased by 2%, 4%, 8% and 10%. According to the reimbursement ratio of medical expenses after aging, it shall not exceed 100%.

Secondary hospital 40090

Tertiary hospital 80085

health clinics in towns and townships

Community service center 16095

Chengdu special outpatient reimbursement deductible standard:

1, urban workers' basic medical insurance participants: 200 yuan, first-class hospital 400 yuan, third-class hospital 800 yuan, community health service center (including township hospitals) 160 yuan.

2. Urban and rural residents' basic medical insurance participants: first-class hospital 100 yuan, second-class hospital 200 yuan, third-class hospital 500 yuan, community health service center (including township hospitals) 100 yuan.

3, a natural year, the first category of diseases excluding Qifubiaozhun; Two or three kinds of diseases are counted as two Qifubiaozhun, which are reduced discontinuously; Calculation of the first payment standard for the fourth kind of diseases.

4, the basic medical insurance for urban workers insured over 100 years of age, excluding Qifubiaozhun.

The latest consultation reply 1. What is the proportion of medical insurance hospitalization reimbursement for non-Chengdu rural household registration personnel who participate in employee social security in Chengdu? Is it different from Chengdu locals?

Reply: The basic medical insurance for urban workers has nothing to do with the insured's household registration. One-time hospitalization expenses incurred by the insured in the designated medical institutions, the amount of which is above the Qifubiaozhun of the overall fund, will be paid by the overall fund according to the proportion of hospital level after deducting the expenses paid by the individual: 85% of tertiary hospitals, 90% of secondary hospitals, 92% of primary hospitals and 95% of community health service centers that have signed hospitalization service agreements with medical insurance institutions. On this basis, the population over 50 years old will increase by 2%, over 60 years old by 4%, over 70 years old by 6%, over 80 years old by 8%, and over 90 years old by 10%. According to the reimbursement ratio of medical expenses after aging, it shall not exceed 100%.

2. Is the reimbursement rate of medical insurance for urban workers in Chengdu the same as that of urban and rural residents? Is the deductible the same?

A: The reimbursement ratio of medical insurance for urban workers in Chengdu is different from that for urban and rural residents, and the minimum payment is also different.

3. What is the reimbursement rate of medical insurance for students and children in Chengdu? What's the consultation number?

Reply: The reimbursement rate of medical insurance for students and children in Chengdu is 90% in township hospitals, 80% in community health service centers and first-class hospitals, 65% in second-class hospitals and 50% in third-class hospitals. Please consult 028- 123333 for details.

Medical insurance is like a huge pool of funds. Some people keep putting money into it, and some people take money from it. As long as there is a balance in the fund pool, the insured can alleviate certain economic pressure when he is sick.

1.20 17 What is the payment standard of medical insurance for urban and rural residents?

(1) Basic medical insurance

Individual payment standards for adult residents: 160 yuan/person-year and 320 yuan/person-year.

Individual payment standard for students and children (including college students): 150 yuan/person-year (including supplementary medical insurance for serious illness and medical insurance for serious and serious diseases).

(2) Supplementary medical insurance for critical illness.

The payment standards of supplementary medical insurance for serious illness are: 460 yuan/person-year and 230 yuan/person-year.

Payment time: 20 1 June1to 20161February 20, if it is overdue, it will not be processed.

Enjoy medical treatment time:1October 17 from 00: 00 to February 3 18 at 24: 00 (college students, from September 16 at 00: 00 to August 20 17 at 20/kloc-0.

There is a waiting period of 6 months (except for students and children) for the first time to participate in supplementary medical insurance for serious illness.

2. What are the medical benefits of medical insurance for urban and rural residents?

(1) hospitalization

The hospitalization medical expenses incurred by the insured in line with the scope of reimbursement can be directly settled by swiping the social security card at the designated medical institution. Details are as follows:

List of hospitalization reimbursement policies of medical insurance for urban and rural residents in Chengdu from 2065438 to 2007

project

Insurance type

basic medical insurance

Serious illness in urban and rural areas

Supplementary insurance for mutual medical assistance for critical illness.

Serious and serious diseases

medical insurance

Payment line

Township hospitals, community health service centers, primary hospitals 100 yuan, secondary hospitals in 200 yuan, tertiary hospitals in 500 yuan, 1000 yuan.

17690 yuan

Consistent with basic medical insurance

No deductible

Hat line

0.2008 million yuan

Open top line

The grade of 460 yuan is 400,000 yuan.

The grade of 230 yuan is 200,000 yuan.

65438+500,000 yuan

(treatment year)

report

sell

compare

example

Adult high-end

92% of township hospitals and community health service centers, and 87% of first-class hospitals; Secondary hospital

82%; 65% of tertiary hospitals.

If the amount of compliance medical expenses borne by single or multiple inpatients exceeds Qifubiaozhun, 50% will be reimbursed for 0-5,000 yuan; The reimbursement rate of more than 5000 -20000 yuan is 60%; 76% will be reimbursed for more than 20,000-50,000 yuan; Proportion of partial reimbursement above 50,000 yuan

An example is 9 1%.

The rest after reimbursement within the scope of the basic medical insurance policy shall be reimbursed by stages and in proportion.

460 yuan grade, the rest 0- 10000 yuan.

The sales ratio is 77%; 10000 -30000 yuan, and the reimbursement ratio of the remaining part is 80%; The reimbursement ratio of the remaining part of 30,000-50,000 yuan is 85%; The remaining 90% will be reimbursed for more than 50,000.

230 yuan grade, the rest 0- 10000 yuan.

The sales ratio is 38.5%; /kloc-40% of the balance of 0/0000-30000 yuan; The remaining 30,000-50,000 yuan will be reimbursed by 42.5%; The proportion of reimbursement for the remaining part of more than 50 thousand yuan is 60%.

Medical expenses that meet the payment conditions of the medical insurance drug list for serious and serious diseases shall be paid by the supplementary insurance fund for medical mutual assistance for serious and serious diseases according to the standard of 70%.

Adult junior

92% of township hospitals and community health service centers, and 85% of first-class hospitals; Secondary hospital

75%; 50% of tertiary hospitals.

student

Children's files

92% of township hospitals and community health service centers, and 85% of first-class hospitals; Secondary hospital

75%; 55% of tertiary hospitals.

Repayment sequence

First basic medical insurance, then serious illness insurance for urban and rural residents, then supplementary medical insurance for serious illness, and reimbursement of total expenses and civil assistance expenses.

Shall not exceed the actual hospitalization expenses.

(2) Outpatient treatment

1. General outpatient service: the reimbursement rate of outpatient medical expenses incurred by the insured in the designated outpatient medical institutions is 60%, and 200 yuan can be reimbursed at most in a natural year.

2. Outpatient special diseases: The medical expenses incurred by the insured that meet the reimbursement scope of outpatient special diseases shall be reimbursed according to relevant regulations.

3. Dog Injury Clinic: The outpatient medical expenses for wound treatment and rabies vaccine injection (including vaccine fee) in the dog injury treatment medical institution shall not exceed 200 yuan per person.

(3) Maternity allowance

Those who participate in the basic medical insurance for urban and rural residents can enjoy maternity insurance benefits for urban and rural residents according to regulations, without paying maternity insurance premiums separately. For pregnant women who meet the family planning policy among the insured, the cost of routine outpatient examination during pregnancy is paid according to the quota of 400 yuan per person; Normal production per person 1.000 yuan in first-class and below medical institutions, and per person 1.400 yuan in cesarean section; Normal production in secondary and above medical institutions 1.200 yuan/person, cesarean section 1.600 yuan/person.

Newborn nursing expenses incurred by the insured during childbirth shall be paid according to the standard quota of RMB 100 per newborn. Reimbursement scope