Hangzhou medical insurance deductible standard

Category of outpatient medical insurance drugs: the personal expenses for participating in the outpatient basic medical insurance system and the number of drugs in the catalogue are mainly determined according to the number of outpatient visits, outpatient expenses, commonly used drugs and comparison with other districts in the whole region. The Qifubiaozhun of Hangzhou medical insurance is determined according to the level of the hospital, namely, 800 yuan, a tertiary and corresponding medical institution, 600 yuan, a secondary and corresponding medical institution, and 400 yuan, other medical institutions. Qifubiaozhun is not calculated cumulatively, but is calculated according to each hospitalization, that is, the part of each hospitalization that exceeds Qifubiaozhun is reimbursed.

What is the deductible for the second reimbursement?

The second reimbursement means that after the medical insurance is settled, if you have insurance to settle elsewhere, you can settle it elsewhere. The specific reimbursement ratio depends on the coverage of the insurance you purchased.

According to the social insurance system, within one year, the first reimbursement deductible amount is 1.300 yuan, and the second reimbursement is determined according to 50% of the first deductible standard. Within one year, the maximum payment limit for medical insurance is 70,000 yuan, and the deductible line for emergency reimbursement for on-the-job employees is 2,000 yuan, and the deductible line for retired employees is 1.300 yuan.

According to the regulations, when the current basic medical insurance is used to pay the hospitalization expenses for the first time in a year, the deductible amount of both working and retired people is 1300 yuan.

The medical expenses for the second and subsequent hospitalization are determined according to the deductible line of 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan. The individual contribution ratio of retirees is 60% of the individual contribution ratio of employees, but the part below the minimum deductible is the same, and all of them are paid by individuals. The standard of hospitalization reimbursement is related to the level of the medical institution where the insured person is located. Note: Outpatient service and hospitalization are two deductible lines.

How much can an employee's medical insurance clinic reimburse at most one year?

Maximum reimbursement for medical insurance for urban workers: outpatient reimbursement, 20,000 yuan; Hospitalization reimbursement, 300,000. Maximum reimbursement for medical insurance for urban residents: outpatient reimbursement: 2,000 yuan; Hospitalization reimbursement: 6.5438+0.7 million yuan. There are two kinds of medical insurance, one is urban workers' medical insurance, and the other is urban and rural residents' medical insurance. Because of the regional differences in medical insurance reimbursement, the regulations are different across the country.

After emergency treatment, employees can only be reimbursed if the medical expenses exceed 2,000 yuan, and the reimbursement ratio is 50%. Retired workers under the age of 70 can be reimbursed for medical expenses exceeding 1300, and the reimbursement ratio is 70%; Retired workers over 70 years old can be reimbursed for medical expenses exceeding 1300 yuan, and the reimbursement rate is 80%. The maximum amount of medical insurance reimbursement for employees of these three groups is 20,000 yuan.

legal ground

"Hangzhou urban basic medical insurance measures" thirty-fifth.

The hospitalization medical expenses incurred by the insured in accordance with the scope of basic medical insurance expenses shall be settled according to the following provisions:

(1) The threshold of hospitalization pooling fund (hereinafter referred to as the threshold) is: 800 yuan, a tertiary and corresponding medical institution, 600 yuan, a secondary and corresponding medical institution, and 400 yuan, other medical institutions. There is a hospitalization qifubiaozhun for each hospitalization. In a natural year, the second hospitalization is calculated according to 75% of the prescribed hospitalization Qifubiaozhun, and the third and above hospitalization is calculated according to 50% of the prescribed hospitalization Qifubiaozhun; Among them, if the insured person needs multiple hospitalizations and chemotherapy treatments due to various malignant tumors, and the retirees who participate in the outpatient co-ordination of retirees are hospitalized due to illness (including multiple hospitalizations), within a natural year, the hospitalization Qifubiaozhun is calculated according to the level of designated medical institutions for the first hospitalization.

(two) the medical expenses of the following part of the hospitalization Qifubiaozhun shall be borne by the individual.

(III) In a natural year, the medical expenses incurred by the insured and shared by the hospitalization pooling fund and the individual shall be paid with a maximum payment limit of 80,000 yuan, which shall be calculated on an annual cumulative basis (subject to the date of discharge), and the medical expenses above the maximum payment limit shall be solved by Medicaid for major diseases.