Proportion of social security hospitalization reimbursement in Dongguan in 2023

The reimbursement ratio of social security hospitalization in Dongguan in 2023 is as follows:

1, hospitalization reimbursement deductible standard:

(1) hospitals below the first level: 100 yuan;

(2) Secondary hospital: 200 yuan;

(3) Level III hospital: 300 yuan.

2, a file of insured hospitalization basic medical expenses and local supplementary medical expenses deductible above, according to the following provisions:

(1) If the insured person has received the employee's pension insurance benefits on a monthly basis in this city and paid the basic medical insurance premium at 1 1.5%, the payment ratio is 95%;

(2) If the primary insured of basic medical insurance pays the basic medical insurance premium at 8%, the payment ratio is 90%;

3, the unit price of more than 1000 yuan of special medical materials and disposable medical materials, installation or replacement of artificial organs:

(1) 90% of the actual price is paid for domestic materials;

(2) The imported materials shall be paid at 60% of the actual price.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC).

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by 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.

Article 31

According to the needs of management services, social insurance agencies can sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.