Qingdao residents medical insurance reimbursement ratio

Reimbursement ratio of Qingdao residents' medical insurance:

1. Students and children. For medical expenses under 180,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for tertiary hospitals is 500 RMB, and the reimbursement rate is 55%; for secondary hospitals, the starting standard is 300 RMB, and the reimbursement rate is 60%; and for primary hospitals, there is no starting standard, and the reimbursement rate is 65%;

2. Elderly people aged 70 years or above. For medical expenses under 100,000 RMB incurred within a settlement year that meet the scope of reimbursement, the starting standard for Level 3 hospitals is 500 RMB, and the reimbursement rate is 50%; the starting standard for Level 2 hospitals is 300 RMB, and the reimbursement rate is 60%; and Level 1 hospitals do not set a starting standard, and the reimbursement rate is 65%;

3. Other urban residents. For medical expenses under 100,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for hospitalization in third-level hospitals is 500 RMB, and the reimbursement rate is 50%; the starting standard for hospitalization in second-level hospitals is 300 RMB, and the reimbursement rate is 55%; and there is no starting standard for first-level hospitals, and the reimbursement rate is 60%.

Urban residents who are hospitalized for more than two times in one billing year will no longer be charged for the starting standard from the second hospitalization. If they are transferred or hospitalized for more than two times, the difference will be made up in accordance with the prescribed starting standard of the hospital to which they are transferred or re-admitted.

Residents' medical insurance reimbursement process:

1. Declaration and settlement information

Invoices of hospitalization settlement with stamps, medical insurance cards, detailed lists of hospitalization expenses with stamps, copies of voluntary letters of the use of medicines other than those listed in the catalog and special diagnostic and therapeutic items with stamps, records of discharge from hospitals with stamps and the "referral order of urban workers' medical insurance" with complete formalities. "

2, settlement

If the participant is hospitalized in a different place with complete procedures, 5 working days after the receipt of vouchers, my ID card directly to the social security center settlement reimbursement. It should be noted that reimbursement is suspended from the 28th to the end of each month and resumed from the 1st of the following month.

In summary, the resident health insurance reimbursement process is the insured patients to prepare a copy of the first page of the medical record, discharge summary, hospitalization receipts, hospitalization medical cost details (one-day list) and other information to the community, the relevant registration; residents of the health insurance agency audit; audit through the medical expenses will be hit the worker's health insurance card.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and treatment items, standards of medical services and facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.