Reimbursement ratio of medical insurance for employees in Qingdao 2023

Proportion of medical insurance reimbursement for Qingdao employees 2023:

First, the proportion of hospitalization reimbursement

1, basic medical insurance

(1) First-class adult residents: 70% in tertiary hospitals, 80% in secondary hospitals and 85% in primary hospitals.

(2) Secondary adult residents: 55% in tertiary hospitals, 75% in secondary hospitals and 85% in primary hospitals.

(3) Children and college students: 80% in tertiary hospitals, 85% in secondary hospitals and 90% in primary hospitals.

2. Serious illness medical treatment

(1) Adult resident level: 80% for over-limit subsidies and 65% for large subsidies.

(2) The second grade of adult residents: 80% of the over-limit subsidy and 62% of the large subsidy.

(3) Children and college students: the over-limit subsidy rate is 85%, and the large subsidy rate is 70%.

Second, the proportion of outpatient co-ordination reimbursement

1, adult residents: 50%;

2. Adult residents in the second grade: 40%;

3. Children: 50%;

4. College students: 80%.

Reimbursement materials

1, original ID card or social security card;

2. Original disease diagnosis certificate issued by tertiary or secondary hospitals of designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If acting as an agent, provide the original ID card of the agent.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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.