2020 medical insurance reimbursement standard

There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. Within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan.

2. Proportion of hospitalization reimbursement

The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

3. Secondary reimbursement ratio

After the "second reimbursement", the medical expenses incurred by the insured residents in a single hospitalization belong to the part paid by the urban residents' basic medical insurance pooling fund, and there may be a "second reimbursement". After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to more than 55%.

After the basic medical insurance payment and "second reimbursement", the annual accumulated hospitalization medical expenses of the insured residents (including the compliant and reasonable self-funded part) exceed 25,000 yuan, and the excess part is "reimbursed" again by the serious illness insurance fund according to the proportion of 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan.

4. Reimbursement amount

The maximum annual reimbursement is 370,000 yuan for residents who participate in medical insurance for urban residents in our city. The annual payment limit for basic medical insurance is 6,543,800 yuan+0.2 million yuan, and the annual payment limit for serious illness insurance is 250,000 yuan. Therefore, the insured can reimburse up to 370,000 yuan per year.

Extended data:

First, medical insurance reimbursement materials

1. Original ID card or social security card.

2, the original disease diagnosis certificate issued by the designated medical institutions.

3, outpatient medical records, inspection, test results report and other original medical certificates.

4. The detailed list of outpatient expenses printed by the hospital computer or the original prescription issued by the doctor.

5. The original unified invoice and computer printed list of tax goods sold by designated pharmacies.

6. The original ID card of the agent is required for the agency.

Second, the reimbursement process

1. Bring the reimbursement materials to the relevant departments of the local social security center for processing. The materials are complete, and those that pass the examination can be handled immediately.

2. When the applicant applies for reimbursement of outpatient medical expenses, the medical insurance premium included in the personal account in this social security year shall be deducted first, and then the reimbursement amount shall be verified.

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