Proportion of medical insurance reimbursement for urban and rural residents

The proportion of medical insurance reimbursement for urban residents is related to the age of the hospital and the applicant for reimbursement, among which:

Third-level hospitals: the minimum threshold for students, children and elderly people over 70 years old is 650 yuan, and the reimbursement rate is 50%; Other urban residents qifubiaozhun is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2000 yuan;

Secondary hospitals: the minimum payment standard for students, children and elderly people over 70 years old is 300 yuan, and the reimbursement rate is 60%; Qifubiaozhun for other urban residents is 300 yuan, and the reimbursement rate is 55%;

First-class hospital: there is no minimum threshold for students, children and elderly people over 70 years old, and the reimbursement rate is 65%; Other urban residents do not set qifubiaozhun, and the reimbursement rate is 60%.

The above reimbursement ratio is based on the medical expenses incurred by students and children within the scope of reimbursement of 6,543,800 yuan+0.8 million yuan in a settlement year; The remaining residents incurred medical expenses that met the scope of reimbursement less than 654.38+10,000 yuan.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates that 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 36 of the Regulations of Beijing Municipality on Basic Medical Insurance stipulates that the medical expenses incurred by employees and retirees in a settlement period shall be calculated by sections and paid cumulatively according to the level of the hospital and the amount of expenses, and shall be shared by the basic medical insurance pooling fund and individuals according to the following proportions:

(1) Medical expenses incurred in tertiary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 85% will be paid by the overall fund and15% by the employees;

2. For the part exceeding 30,000 yuan to 40,000 yuan, 90% shall be paid by the overall fund and10% by the employees;

3 more than 40 thousand yuan, the overall fund to pay 95%, workers pay 5%.

(two) medical expenses incurred in secondary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 87% will be paid by the overall fund and13% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(3) Medical expenses incurred by first-class hospitals and family beds:

1. 90% of the minimum threshold is 30,000 yuan, and 90% is paid by the overall fund and10% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(4) The individual contribution ratio of retirees is 60% of the employees.

However, the maximum amount of proportional payment of the basic medical insurance pooling fund shall not exceed the maximum payment limit stipulated in Article 33 of these Provisions.

When the payment ratio of the basic medical insurance fund listed in the first paragraph of this article needs to be adjusted, the municipal labor and social security administrative department shall, jointly with the municipal finance department, put forward an adjustment plan, which shall be promulgated and implemented after being approved by the Municipal People's government.