Proportion and scope of medical insurance reimbursement in Qingdao

First, the proportion of hospitalization reimbursement

1, basic medical insurance

Adult level 1: 70% in tertiary hospitals, 80% in secondary hospitals and 85% in primary hospitals.

The second grade of adult residents: 55% in tertiary hospitals, 75% in secondary hospitals and 85% in primary hospitals.

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

2. Serious illness medical treatment

Adult resident level: 80% over-limit subsidy and 65% large subsidy.

The second grade for adult residents: 80% for over-limit subsidies and 62% for large subsidies.

Children and college students: 85% are over-limit subsidies, and 70% are large subsidies.

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%.

Qingdao medical insurance reimbursement quota

The amount of medical insurance reimbursement for Qingdao residents stipulates that the maximum payment limits for medical expenses incurred by insured persons in designated medical institutions are 200,000 yuan and 6,543.8+0.8 million yuan respectively; The maximum payment limit of medical insurance for serious illness is 600 thousand yuan; The maximum payment limit of supplementary medical insurance is 200 thousand yuan; There is no maximum payment limit for special drugs and special materials assistance, and the specific reimbursement ratio varies according to different hospital levels, different expenses and different types of insurance, such as:

First, the general outpatient quota:

1 limit of outpatient medical reimbursement for residents with first-class medical insurance in 720 yuan.

2 second class medical insurance residents and children's outpatient medical reimbursement limit in 400 yuan.

Two, hospitalization reimbursement limit:

The maximum reimbursement for hospitalization is 6.5438+0.8 million yuan.

Provisions of Qingdao Municipality on Emergency Reimbursement

The emergency expenses incurred by the insured in the designated medical insurance institutions shall be included in the general outpatient department for overall settlement and reimbursement after being audited by the medical insurance management department of the designated medical institutions. However, the emergency medical expenses of designated medical institutions incurred by the insured in the general outpatient service of non-medical insurance designated institutions shall not be paid.

The medical expenses of the insured who died after emergency rescue, the medical expenses during emergency observation and hospitalization observation, and the medical expenses of the insured for emergency treatment of approved diseases in outpatient department are not included in the overall payment scope of ordinary outpatient department.

Qingdao Medical Insurance Reimbursement Process

1. First of all, when going through hospitalization procedures: medical insurance patients should show their ID cards and medical insurance, and then go through hospitalization procedures and register. Only in this way can we ensure that some expenses in the hospital are included in the scope of medical insurance reimbursement.

2. If you want to leave the hospital, you need:

The diagnosis certificate issued by the attending physician will take effect after being stamped at the outpatient charge office;

Notice of hospitalization and receipt of hospitalization deposit; Id card, medical insurance card.

3. With the above procedures and materials, just go to the window where you go through the hospitalization procedures to handle discharge and reimbursement.

4. After the completion, the staff will give you a discharge notice, including the details of various expenses, the scope of reimbursement, the amount of reimbursement and so on.

Proportion of medical insurance payment in Qingdao

The first is the proportion of corporate social insurance contributions.

Endowment insurance: the unit pays 16% and the individual pays 8%;

Medical insurance: 9.5% for units and 2% for individuals.

Unemployment insurance: the unit pays 0.7% and the individual pays 0.3%;

Work-related injury insurance: it is divided into eight categories according to industry categories, namely 0.05%, 0. 1%, 0. 18%, 0.23%, 0.28%, 0.33%, 0.4% and 0.48%, and employees do not need to pay fees;

Note: From June 5438+ 10/day, 2020, maternity insurance and employee medical insurance will be collected in a unified way, and the maternity insurance fund will be merged into the employee medical insurance fund, so maternity insurance premium will no longer be collected separately.

The second is the proportion of social security contributions of individual industrial and commercial households with employees.

Employee pension: unit 12%, individual 8%.

Medical insurance for employees: 9.5% for units and 2% for individuals.

Unemployment insurance: 0.7% for employers and 0.3% for individuals.

Maternity insurance: 1.5%, not paid by individuals.

Industrial and commercial insurance: it is divided into eight categories according to industry categories, namely 0.05%, 0. 1%, 0. 18%, 0.23%, 0.28%, 0.33%, 0.4% and 0.48%, and employees do not pay fees;

Third, flexible employees.

Employee pension: 20%

Employee medical insurance: 10%.

How many years does Qingdao medical insurance pay?

1. Minimum payment period of old-age insurance 15 years, and you can receive a monthly pension after retirement.

2. The minimum payment period of medical insurance is 20 years for women and 25 years for men.

3. Generally, the old-age insurance can be interrupted, and the accumulated payment is 15 years. If the minimum payment period at retirement is not enough, it can be filled; Medical insurance can also be interrupted, but it is best not to interrupt without reason, because if you are hospitalized during the interruption, the treatment expenses cannot be reimbursed. Once interrupted, if retirement is not enough to pay the minimum age, it can be made up. Therefore, how many years to pay endowment insurance and medical insurance should be based on your actual situation. If you want to get more economic security in the future, you must buy endowment insurance at least 15.

How to handle medical insurance for serious illness in Qingdao?

1. The insured person shall bring the required information, inpatient and outpatient medical records, discharge records, social security cards and related inspection reports, among which patients with chronic diseases such as hypertension and diabetes shall provide outpatient medical records issued by hospitals with a level of two or more years and other inspection and treatment materials related to the applied diseases, and apply to the social security agency for outpatient serious illness;

2, the insured person in the window to fill out the "outpatient illness qualification application form", to outpatient illness special medical records and prescriptions to the designated medical institutions outpatient illness window to receive;

3. The staff accepts the materials and reviews them. If the materials are incomplete, inform the insured to fill them up;

4, after the audit meets the conditions, collect information, 10 working days to apply for outpatient serious illness certificate.

5. If it is necessary to change the designated medical institutions after the expiration of the medical year, it shall first go to the original designated medical institutions to review and reimburse the expenses of the previous year, and then apply for change at the nearest window of the Social Security Bureau.

Related question and answer

Can Qingdao medical insurance be interrupted for two months?

Answer: Medical insurance is different from social security. You can make up after the social security is interrupted, because it will be used after retirement. As long as people are alive, they can make it up. If you have medical insurance, you can enjoy it if you have it. If you are interrupted, you can't enjoy it during the interruption. But if you pay it again, you can enjoy it later, but it can't make up for the medical expenses during the interruption. And usually medical insurance is handled this month, and you can't start enjoying it until next month.

How long does it take to get a medical insurance card in Qingdao?

Answer: It's usually quick to get a medical insurance card. You can ask the company. If you really deduct money to participate in insurance, you must have a card. This will be completed in about one month.

Can Qingdao medical insurance card be used across provinces?

Answer: medical insurance can be used for reimbursement in different places.

Medical insurance for medical treatment in different places:

1. You need to bring the insured's ID card and medical insurance card to the municipal medical insurance hall to get the registration form of the residents living in different places in the municipal medical insurance.

2, according to the provisions of the fill in and seal to the medical insurance institutions in different places.

3. Bring the completed application form back to the medical insurance institution of the insured place for review and confirmation.

4. When you are hospitalized, please call the municipal medical insurance center to register in time.

5. Within one month after discharge, bring hospitalization receipt, expense details, copy of case and copy of this form to reimburse hospitalization medical expenses.

6. Choosing a hospital for medical treatment must be a designated hospital for medical insurance in the place of residence.

7, inter-annual medical expenses must be settled annually.