The latest provisions of health insurance in Guangyuan City in 2022: the scope of reimbursement, proportion, contribution standard

Introduction:

2019 Guangyuan City, what is the latest provisions of health insurance according to the Guangyuan Human Resources and Social Security Bureau issued a relevant announcement of the latest provisions of health insurance in 2019 Guangyuan, the following for the compilation of Guangyuan health insurance reimbursement scope, reimbursement ratio, contribution standards for reference only.

2019 Guangyuan medical insurance reimbursement range

a) medical expenses for hospitalization

medical expenses within 7 days before emergency detention and transfer to hospitalization

medical expenses in line with the provisions of special outpatient diseases for urban residents

other expenses in line with the provisions

It is reported that Guangyuan expanded the scope of outpatient special disease categories, from the original 27 kinds to 47 kinds The number of outpatient special diseases has increased from 27 to 47, with an increase in both the first and second categories of special diseases. Now the city also belongs to the national "rare disease catalog" in the rare diseases, into the city health insurance outpatient second class special disease scope of management, such as congenital myasthenia gravis syndrome, hereditary multiple cerebral infarction dementia, osteogenesis imperfecta and so on. Their outpatient medical fees are reimbursed according to the standard of hospitalization fees in secondary hospitals.

At the same time, improve the settlement of outpatient medical fees for two types of special diseases. Participating in the urban workers, urban and rural residents of the basic medical insurance personnel of the two types of special diseases outpatient medical fees, should be paid by the medical insurance fund is not included in the total budget of the medical institution hospitalization medical fees, by the medical insurance agency on a monthly basis with the medical institution according to the actual settlement.

2019 Guangyuan health insurance reimbursement ratio

Working employee health insurance reimbursement ratio:

1, after visiting the outpatient clinic and emergency clinic of the hospital, only medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;

2, if it is a retired person under the age of 70 years old, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%;

3, if the retiree is over 70 years old, more than 1300 yuan of expenses can be reimbursed reimbursement rate is 80%.

Note: Regardless of the type of person, the maximum limit for outpatient and emergency large medical expenses paid is 20,000 yuan.

In the case of hospitalization, the starting amount is 1,300 yuan for the first time in a year when you use basic medical insurance to pay, regardless of whether you are an active employee or a retiree.

And for the second and subsequent hospitalization medical expenses, the starting standard is determined by 50%, which is 650 RMB. And the maximum payment from the Basic Medical Insurance Coordination Fund in a year is currently 70,000 yuan.

The standard of hospitalization reimbursement is related to the level of the hospital where the insured person is staying:

Note: If you are staying in a tertiary hospital.

1, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement;

2, 30,000 yuan to 40,000 yuan, the employee pays 10%, reimbursement of 90%;

3, more than 40,000 yuan to the maximum payment limit part of the cost, 95% of the cost of the reimbursement, the employee only need to pay 5%;

4, the proportion of the retiree's personal payment is the active 60% of the employees.

2019 Guangyuan City medical insurance contribution standards

Contribution ratio

Guangyuan City medical insurance payment ratio is unified: individuals bear 2%, the unit bears 7.5%

Contribution base

The 2017 medical insurance contribution base range is:

The upper limit of the monthly contribution base is:12,844 yuan

The lower limit of the contribution base is:3,426 yuan

The above data is based on the network and various official websites published information collated, the specific policy to the final document implementation shall prevail, the specific workday consulting Guangyuan City Social Security Center.

Guangyuan Human Resources and Social Security Bureau

Address: No. 667, Lizhou East Road, Guangyuan City

Phone: 0839-12333