Proportion of reimbursement of hospitalization medical insurance in Jinan city

Proportion of hospitalization medical insurance reimbursement in Jinan:

1, and the reimbursement rate of community health service institutions is 80%;

2. The reimbursement rate of first-class hospitals is: 80%;

3. The reimbursement rate of secondary hospitals is 75%;

4. The reimbursement rate of tertiary hospitals is 70%.

Qifubiaozhun for hospitalization is:

1, Qifubiaozhun of community health service institutions: 300 yuan;

2. The Qifubiaozhun for first-class hospitals is: 500 yuan;

3. Qifubiaozhun for secondary hospitals is: 800 yuan;

4. The minimum threshold for tertiary hospitals is: 1000 yuan.

Medical insurance reimbursement materials:

1, ID card;

2. Social security card;

3. Leave invoices for hospitalization expenses;

4, the original hospitalization expenses summary list;

5. The first page of medical records;

6. Discharge summary;

7. Cost summary table;

8. Expense receipt;

9, door (emergency) medical records and inspection reports (emergency);

10, pathological examination report;

1 1, operation record;

12, long-term and temporary orders;

13, other required information.

To sum up, if the insured is hospitalized in a designated hospital in this city during the period of enjoying medical insurance benefits, and the medical expenses are not directly settled in the hospital through the medical insurance computer network, the medical insurance fund Qifubiaozhun shall be implemented according to the standards of similar designated medical institutions in this city.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.