How to reimburse the proportion of hospitalization social security in Hefei

What is the proportion of hospitalization reimbursement for urban medical insurance insured residents in Hefei this year? Recently, the relevant person in charge of Hefei Labor and Social Security Bureau answered this question.

According to reports, the minimum threshold for each hospitalization of insured residents is: tertiary hospital 600 yuan, secondary hospital 400 yuan, primary hospital or community health service center 200 yuan. The medical expenses incurred by the insured residents in hospitalization within the scope of the residents' medical insurance fund shall be paid by the individual, and the above part of the fund Qifubiaozhun shall be paid jointly by the fund and the individual according to the different grades of medical institutions. The proportion of fund payment is: 50% for tertiary hospitals, 60% for secondary hospitals, and 70% for primary hospitals, among which, the insured residents with Class I minimum living allowances and severe disabilities are paid by the fund.

In one year, the maximum amount of medical insurance benefits for insured residents' hospitalization (including off-site transfer and off-site emergency treatment) and special disease outpatient service is 18, and the maximum amount of fund payment for students under the age of 8 and non-employed residents is 654.38+10,000 yuan per year, and the above amount shall be borne by individuals. The maximum payment limit for other urban residents and rural residents under the jurisdiction of the city is 50 thousand yuan per person per year, and the part exceeding the limit shall be borne by the individual.

The insured need hospitalization due to illness, should hold my medical insurance card for hospitalization and discharge settlement procedures. At the time of discharge settlement, the medical expenses that the individual should bear shall be settled by the individual directly with the designated medical institutions according to the facts; The medical expenses borne by the medical insurance fund shall be settled by the municipal medical insurance agency and the designated medical institution. The hospitalization expenses incurred by insured residents who fail to show their medical insurance cards shall be paid by individuals.

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