Proportion, policies, conditions and scope of medical insurance reimbursement from 2002 to 2022 in Weihai.

Reimbursement scope of Weihai medical insurance

According to the provisions of the Social Insurance Law, medical insurance can be reimbursed in accordance with the relevant provisions if it meets the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses.

Reimbursement ratio of medical insurance in Weihai City

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Basic medical insurance benefits for urban residents

Hospitalization medical insurance benefits: hospitalization in different levels of hospitals, enjoy different treatment. Specifically, within one year, the reimbursement rates of hospitalization medical expenses with the minimum threshold of 1000 yuan are 60%, 55% and 50% in the first, second and third level hospitals respectively; From 65,438 yuan+0,000 yuan to 30,000 yuan, the reimbursement rates are 65%, 60% and 50% respectively. Among them, if urban residents have been insured for more than 5 years without hospitalization medical expenses, the reimbursement ratio will increase by 5 percentage points; Over 10 years, increasing by 10 percentage point. The reimbursement rate of medical expenses exceeding 30,000 yuan to 654.38+10,000 yuan is 70%.

Medical insurance treatment for outpatient specific diseases: outpatient specific diseases mainly include radiotherapy and chemotherapy for malignant tumors, dialysis treatment for chronic renal failure, anti-rejection treatment after organ transplantation, chronic hepatitis and so on. Suffering from these four kinds of outpatient diseases, the reimbursement ratio is the same as the hospitalization medical expenses, and the quota management is implemented.

Outpatient medical insurance benefits for accidental injuries of persons without responsibility: When the insured persons have accidental injuries of persons without responsibility, their medical expenses will be included in the payment scope of urban residents' medical insurance fund. The outpatient medical expenses exceeded 100.

More than 60% is paid by the medical insurance fund, with a maximum payment of 2000 yuan a year.

If the medical insurance premium is paid beyond the prescribed payment time and the payment is less than one year, the medical insurance benefits will be paid according to the actual payment months; Those who pay the annual medical insurance premium will enjoy the annual medical insurance benefits, but the medical expenses incurred within 3 months before and after payment will not be paid by the medical insurance fund.

The above-mentioned insurance benefits refer to the expenses within the scope of drug list, diagnosis and treatment project list and service facilities stipulated by the state. Beyond the scope of the catalogue, the medical insurance fund will not pay.

Qifubiaozhun of basic medical insurance for urban residents

When enjoying medical insurance benefits, the amount of medical expenses paid by individuals is called Qifubiaozhun.

Qifubiaozhun is determined according to the hospital level. The qifubiaozhun of the first, second and third level hospitals are 300 yuan, 500 yuan and 800 yuan respectively. In a natural year, if the medical expenses for the first and second hospitalization of the insured reach or exceed the Qifubiaozhun, there is no Qifubiaozhun from the third hospitalization; If the Qifubiaozhun is not reached, the difference between the first two Qifubiaozhun should be partially made up when the hospitalization expenses are settled from the third hospitalization.

The insured person suffering from outpatient specific diseases in designated medical institutions for outpatient treatment, Qifubiaozhun for 300 yuan.

The deductible standard of outpatient medical expenses for accidental injury is 100 yuan.

Urban workers

The threshold of medical insurance for employees is 400, 700 and 900 yuan in the first, second and third level hospitals respectively.

In terms of reimbursement of hospitalization expenses, the reimbursement ratio is: 90% in first-class hospitals, 85% in second-class hospitals and 80% in third-class hospitals; 1 0,000 yuan to 40,000 yuan, the reimbursement ratio is: 92% for first-class hospitals, 90% for second-class hospitals and 88% for third-class hospitals. For the part exceeding 40,000 yuan, a large amount of medical insurance assistance will be implemented, and the maximum payment limit is 460,000 yuan.

The specific proportion of assistance is determined by stages: the proportion of assistance with medical expenses exceeding 40,000 to 240,000 yuan is 90%, and the proportion of assistance with medical expenses exceeding 240,000 to 500,000 yuan is 80%. The qifubiaozhun and the annual payment limit of inpatient medical expenses for retirees are the same as those for on-the-job employees; For the part exceeding Qifubiaozhun, the personal burden ratio is half of that of the employees.