Proportion of medical insurance reimbursement in Fuyang city

What is the proportion of medical insurance reimbursement? This is a very complicated problem, not to mention that the medical insurance policy has various regulations due to different regions, and even there are many kinds of medical insurance drugs. In addition, the ratio of outpatient reimbursement to hospitalization reimbursement is really difficult to calculate. 1. Different hospitals have different reimbursement rates for medical insurance. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not medical insurance and cannot be reimbursed. 2. On-the-job employee hospitalization medical insurance reimbursement ratio hospitalization, except for the self-funded part and self-paid 10%, the part exceeding the deductible expenses of hospitalization medical insurance enjoys the overall payment ratio. Different levels of hospitals have different threshold fees and enjoy different proportions of overall payment. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan). From this perspective, the proportion of self-funded medical insurance hospitalization is hard to say. All self-funded parts are self-funded, and all threshold fees are self-funded. The second-class expenses shall be paid by 65,438+00% first, and then by 20% together with the first-class expenses. Very complicated! In fact, the computer system will automatically calculate. Medical insurance hospitalization, show the medical insurance card, read the card into the medical insurance system, pay the deposit (usually the threshold fee), and enter the fee into the system. The system automatically classifies it as self-funded, Class A, Class B, etc. Class B pays 65,438+00% first, and then enters the basic medical care. According to the number of hospitalizations per year (more than 1 deductible expenses are halved) and hospital level (deductible expenses are different), the calculation formula is as follows: if the medical expenses total 9,000 yuan, the reimbursement formula is [9000-500 (deductible expenses)-self-funded drugs ]*80%. If self-funded drugs account for a large proportion, there is not much amount to be reimbursed. 3. Proportion of reimbursement of supplementary medical insurance for retirees. Ms. Zhang, who lives in Shijingshan District, Beijing, reported that after retiring in 2000, she had to go to the hospital for a prescription every month because of chronic diseases. In the past, the reimbursement rate was always about 88% (for retirees under 70 years old, 70% of large medical expenses were paid by mutual funds, and 60% of the remaining 30% could be reimbursed by supplementary medical insurance, which was 88%). But now it is said that the proportion of supplementary medical insurance in social security card (that is, medical insurance card) is 50%, so only 85% can be reimbursed. She wants to know whether the social security card has adjusted the proportion of medical reimbursement. The staff of the Social Security Bureau replied that the social security card did not adjust any medical reimbursement ratio. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. If the reimbursement rate of Ms. Zhang's supplementary medical insurance is 60%, it should be because the funds reimbursed by Ms. Zhang's original unit are higher than the social supplementary medical insurance. After using the social security card, it can still be reimbursed according to the reimbursement ratio provided by the original unit, that is, 60% of the supplementary medical insurance.