What is the proportion of general hospitalization reimbursement?

1, level 1 hospital, 90% for the part above the minimum threshold;

2. For secondary hospitals, the minimum threshold is reduced by 85% to 1 10,000 yuan, and the maximum payment limit is reduced by 90% to 1 10,000 yuan;

3. 80% will be paid for the minimum deductible of 5,000 yuan, 85% for the minimum deductible of 5,000 yuan to 1 10,000 yuan, and 90% for the maximum payment limit of 1 10,000 yuan;

4. Retirees will increase by 5% on the basis of the above payment ratio.

Proportion standard of hospitalization reimbursement:

1. Proportion standard for reimbursement of auxiliary examination expenses: the examination expenses such as electrocardiogram, X-ray fluoroscopy, photography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance shall be reimbursed to 200 yuan; In other words, if 400 yuan is needed for filming, 200 yuan can only be reimbursed at the end of reimbursement;

2. Proportion standard for reimbursement of operation expenses: refer to national standards, and the part exceeding 1 ,000 yuan shall be reimbursed as 1 ,000 yuan; The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan;

3. The reimbursement rate standard of hospitals at all levels: the reimbursement rate of town hospitals is 60%; The reimbursement rate of secondary hospitals is 40%; The reimbursement rate of tertiary hospitals is 30%.

To sum up, social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. It is undertaken by the government and implemented and managed by economic, administrative and legal means. Social medical insurance consists of basic medical insurance and large medical assistance, enterprise supplementary medical insurance and individual supplementary medical insurance.

Legal basis:

Social insurance law

second

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

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.

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 29

The hospitalization expenses for major diseases are paid in the following ways:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion.

Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.