The proportion of medical insurance reimbursement for minimally invasive surgery expenses in kidney calculi

Kidney calculi minimally invasive surgery reimbursement is divided into rural residents and urban workers:

1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

2. Social security: within a settlement year, for urban workers, the medical expenses below 654.38 million yuan that meet the scope of reimbursement, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

3. You need to go back to your hometown (insured place) for reimbursement in different places, and the reimbursement ratio is 35-65%, which varies according to the level of the hospital.

In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

1. First-class hospital, 90% of the part above Qifubiaozhun to the highest payment limit.

2. Secondary hospitals pay 85% of the minimum deductible line 1 10,000 yuan (inclusive) and 90% of the maximum payment limit 1 10,000 yuan.

3. 80% of the minimum deductible of tertiary hospitals is above 5,000 yuan (inclusive), 85% of the minimum deductible of 5,000 yuan to 10000 yuan, and 90% of the maximum deductible of 10000 yuan.

4. Retirees will increase by 5% on the basis of the above payment ratio.

legal ground

"People's Republic of China (PRC) social insurance law" thirtieth the following medical expenses are not included in the scope of payment of the basic medical insurance fund:

(a) shall be paid from the industrial injury insurance fund.

(2) borne by a third party.

(three) shall be borne by the public health.

(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.