Nanjing residents health insurance 2024 reimbursement ratio

Nanjing Residents' Health Insurance 2024 Reimbursement Ratio:

1. General Outpatient Clinic. For residents who visit community hospitals, the part of the cost within 200 yuan has to be borne by individuals, and the fund pays 60% of the cost between 200 and 900 yuan, while the fund pays 50% of the cost for visits to other hospitals. For residents over 80 years of age, the fund pays 65 percent at community hospitals and 55 percent at other hospitals.

2. For outpatient major diseases, the fund pays 50% of the portion above 20,000 yuan to 40,000 yuan; 55% of the portion above 40,000 yuan to 60,000 yuan; 60% of the portion above 60,000 yuan to 80,000 yuan; 65% of the portion above 80,000 yuan to 100,000 yuan; and 70% of the portion above 100,000 yuan.

3. Hospitalized major diseases. The starting standard is different according to the level of hospitals, the starting standard of third-level hospitals is 1,000 yuan, and the fund pays 65%; the starting standard of second-level hospitals is 500 yuan, and the fund pays 85%; the starting standard of first-level hospitals is 300 yuan, and the fund pays 90%.

Nanjing residents health insurance reimbursement process:

1, the processor to submit reimbursement documents and other materials to the deep gray insurance fund management bureau to accept.

2, the acceptance of the department since the receipt of application materials, health insurance center the same day to complete the audit, settlement, payment work.

3. The Social Insurance Fund Administration Bureau reviews the materials and approves the application, and the applicant is reimbursed after receiving the Reimbursement of Social Health Insurance Medical Expenses.

In summary, the adjustment of the reimbursement ratio of Nanjing 2024 residents' medical insurance reflects that the medical insurance policy is constantly optimized and improved to better adapt to the medical needs of the insured residents and to ensure the fairness and sustainability of the medical insurance.

Legal basis:

The People's Republic of China*** and the State Social Insurance Law

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.