What percentage of Wujiang social security reimbursement?

Study on the proportion of hospitalization reimbursement of basic medical insurance in Wujiang city

As far as I know, the current reimbursement methods for hospitalization of basic medical insurance in Wujiang are as follows:

(If my understanding is inconsistent with the policy, the policy shall prevail)

(1) On-the-job insured:

Deduct self-funded items first, such as those above the bed fee limit, accompanying beds, blood expenses, albumin and other self-funded items or drugs;

Secondly, the proportion of deducting certain drugs or examination and treatment items that individuals have to pay first varies from 5% to 20%;

Thirdly, 400 yuan's deductible should be deducted;

84% of the remaining expenses are included in the scope of reimbursement.

In other words, except for the three parts that are not easy to be reimbursed, the part that is easy to be included in reimbursement is 84%.

On the other hand, it includes four parts: self-funded items+proportional self-funded part +400 yuan deductible part +65438+ 06% of the remaining amount.

(2) General retired insured:

Change the above reimbursement rate from 84% to 92%. Yes:

Deduct self-funded items first, such as those above the bed fee limit, accompanying beds, blood expenses, albumin and other self-funded items or drugs;

Secondly, the proportion of deducting certain drugs or examination and treatment items that individuals have to pay first varies from 5% to 20%;

Thirdly, 400 yuan's deductible should be deducted;

The remaining expenses are included in the reimbursement range of 92%.

In other words, except for the three parts that are not easy to be reimbursed, the part that is easy to be included in reimbursement is 92%.

In this way, the self-funded expenses also include four parts: self-funded items+proportional self-funded parts+deductible in 400 yuan+8% of the remaining amount.

In addition:

1. For the second hospitalization or above in the medical insurance year, the deductible is reduced to 300 yuan.

2, chemotherapy patients in hospital, cancel Qifubiaozhun, preferential reimbursement for chemotherapy drugs, do not implement computer credit card settlement. Patients discharged from the hospital after filling out the application form in the medical insurance department can be reimbursed directly to the medical insurance department with the discharge receipt, list and discharge record.

3. In the field of hospital treatment, you must first go through the transfer procedures, and the local hospital (Wujiang Third Hospital) will issue a transfer certificate, and Wujiang medical insurance department will stamp the license before you can transfer to hospital for treatment. After discharge, with the discharge receipt, list and discharge record, directly go to the medical insurance department for reimbursement and settlement.

4. A large number of materials and instruments involved in the treatment process, such as artificial joints, pacemakers, transplants, etc. , must first apply to the municipal medical insurance department.

5. Non-insurance diseases or events stipulated by medical insurance shall not be included in the reimbursement scope of medical insurance. Please refer to the post "reimbursement ratio of cooperative medical care".

If you want to know more about insurance, you can go to >> "Raise more fish and talk about insurance" for free consultation!