Hebei medical insurance reimbursement policy

In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

2. At least 70 years old and above.

In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

Specific standards

1, Qifubiaozhun for urban residents. First-class hospital 400 yuan, second-class hospital 600 yuan, third-class hospital 900 yuan;

2. The proportion of residents' contributions. If 80% of the first-level hospitals, 70% of the second-level hospitals and 60% of the third-level hospitals continue to participate in the insurance payment, from the second year of continuous payment, the proportion of hospitalization reimbursement will increase by 1% every year, with a maximum increase of 10 percentage point;

3, the general outpatient Qifubiaozhun 200 yuan, residents reimbursed 50%;

4, urban workers Qifubiaozhun above 1000 yuan to pay 50%, 1000 yuan to 20000 yuan to pay 60%, 20000 yuan to 30000 yuan to pay 70%, 30000 yuan to 40000 yuan to pay 80%, 40000 yuan to the highest payment limit to pay 90%;

5, the proportion of personal burden reimbursement of hospitalization medical expenses. On-the-job insured workers are hospitalized in county and urban medical institutions within the scope of this Municipality. The deductible line and payment ratio of medical expenses are 92% in 200 yuan and 90% in 300 yuan. Hospitalization in medical institutions in Gaocheng District, Luquan District, Luancheng District, mining area and Zhengding County shall be implemented with reference to this payment method;

6, urban insured workers. For medical treatment in a first-class medical institution, the deductible line is 200 yuan, and the payment ratio is 90%; Secondary medical institutions, deductible line 700 yuan, the payment ratio is 85%; Municipal tertiary medical institutions, the deductible line is 900 yuan, and the payment ratio is 83%; For provincial tertiary medical institutions, the deductible line is 1.200 yuan, and the payment ratio is 80%. After filing, transfer to other cities in the province for medical treatment, with reference to this payment method;

7. If the employee is transferred to a medical institution with medical insurance agreement outside the province after being filed by the insured agency, the deductible line for each time is 1500 yuan, and the payment ratio is 76%;

8. Qifubiaozhun for common diseases in urban outpatients. Level-1 and below medical institutions in 700 yuan, level-2 medical institutions 1000 yuan, level-3 medical institutions 1500 yuan. The basic medical insurance fund pays 80% of the first-class and below medical institutions, 70% of the second-class medical institutions and 60% of the third-class medical institutions.

The insured workers of basic medical insurance at the same level in Hebei Province are hospitalized in the designated medical institutions of the first, second and third level medical insurance, and the hospitalization Qifubiaozhun is 500 yuan, 650 yuan and 800 yuan respectively. Within one year, employees who have been hospitalized for many times in the same level of medical institutions, and the medical expenses for the last hospitalization exceed the Qifubiaozhun, will be reduced by 20% in turn on the basis of the Qifubiaozhun of the medical institution where they live, with a minimum of not less than 200 yuan.

Take Shijiazhuang as an example: there is no deductible line for drug reimbursement in urban and rural "two diseases" clinics, and the reimbursement ratio within the scope of the program is 50%. The highest reimbursement for hypertension is 225 yuan per person per year, and the highest reimbursement for diabetes is 375 yuan per person per year.

Provincial outpatient special disease reimbursement scheme and settlement method The insured person is targeted at drug treatment caused by radiotherapy, chemotherapy and endocrine therapy in malignant tumor outpatient department; Outpatient service after organ transplantation. Anti-rejection therapy; Outpatient medical expenses incurred in outpatient treatment of hemophilia shall be calculated according to the hospitalization plan and the number of inpatients in one year. After exceeding the deductible line, the expenses will be reimbursed in proportion. Outpatient hemodialysis and peritoneal dialysis with renal insufficiency are subject to single disease management, quota and quota settlement. The outpatient medical expenses incurred by the insured due to "outpatient special diseases" shall be settled directly by social security card in designated medical institutions. The expenses that should be borne by the insured shall be paid by personal account or cash; Co-ordinate the expenses paid by the base, keep accounts at designated points, and the provincial medical insurance bureau pays and settles monthly.

Legal basis:

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 7 The composition of the total wages for paying the basic medical insurance premium shall be calculated according to the relevant provisions of the state. The basic medical insurance premium paid by the employer shall be charged according to the relevant financial regulations of the state. The basic medical insurance premium is not included in the personal current wage income, and is exempt from personal income tax. The employing unit shall not lower the wage standard of employees on the grounds that they pay the basic medical insurance premium.