Which is the higher proportion of reimbursement for serious illness in Xining and Xi 'an?

You have to compare this according to the local actual situation.

The proportion of medical insurance reimbursement for employees in Xining in 2020, the new policy of medical insurance reimbursement for social security in different places in 2020, the scope of medical insurance reimbursement in Xining in 2020, and the reimbursement process for hospitalization medical insurance.

Reimbursement ratio

Urban workers:

Qifubiaozhun:

The hospital level is Grade I: 350 yuan.

The hospital level is Grade II: 550 yuan.

The level of the hospital is Grade III: 750 yuan.

The reimbursement ratio is:

The level of the hospital is Grade I: 85% of employees and 90% of retired employees;

The level of the hospital is Grade II: 80% of employees and 85% of retired employees;

The level of the hospital is three levels: 75% of employees and 80% of retired employees;

Tips: During the year, the minimum threshold for the second hospitalization was reduced by 100 yuan, and the 50 yuan was reduced again for the third hospitalization. The reimbursement ratio remains unchanged, and the employee medical insurance cap line is 220,000 yuan.

1, the individual pays for treatment items:10%;

2. Individuals pay disposable medical materials first:10%;

3. Individuals pay for oral medical materials first: 20%;

4. The proportion of advance payment for individual patients who go abroad for medical treatment: 10%.

Medical assistance for serious diseases

On-the-job employees are paid 55% by the serious illness relief fund, and medical institutions, employers and individuals each bear15%;

70% of the serious illness medical expenses of retirees are paid by the serious illness relief fund, and medical institutions and individuals bear 15%.

Urban residents:

Reimbursement of hospitalization medical expenses:

Transfer: The total hospitalization expenses 10% shall be paid. After deducting hospitalization deductible line 1500 yuan, the expenses within the policy scope shall be reimbursed according to the reimbursement standard of tertiary medical institutions, with the reimbursement ratio of 70%.

Rural residents:

1, outpatient fee: 40 yuan per person per year;

2. Hospitalization expenses:

Qifubiaozhun: provincial hospital 500 yuan, municipal hospital 350 yuan, district hospital 100 yuan, township hospital 50 yuan;

Reimbursement ratio:

After deducting Qifubiaozhun, medical and drug expenses of self-funded items:

Provincial reimbursement 60%, municipal reimbursement 70%, district reimbursement 70%, township hospitals reimbursement 90%.

Reimbursement scope

Medical insurance expenses are not reimbursed:

(1) Define the medical expenses paid by the industrial injury insurance fund;

(2) Traffic accidents (except the relevant escape certificate issued by the public security traffic management department), accidents, medical accidents, etc. This is obviously the responsibility of a third party;

(3) It should be borne by public health;

(4) Going abroad for medical treatment;

(5) Other expenses that shall not be paid according to laws and regulations.

Reimbursement conditions

Urban workers

1. Insured employees are hospitalized outside the city:

Hospitalization due to illness → the unit fills in the examination and approval form for hospitalization outside the city → the examination and approval of Xining Medical Insurance Center → the medical insurance center after discharge → the treatment declaration → the treatment review → the treatment payment;

2, the insured workers outside the hospital for medical treatment:

The chief physician issued a summary of the medical records of referral and referral → the audit records of the hospital medical insurance office → the audit records of Xining medical insurance center for treatment → the audit records of medical insurance center for discharge treatment → treatment payment;

3, off-site personnel outpatient illness:

Outpatient critical illness declaration process

4, the local staff outpatient illness:

Serious illness in outpatient service of local personnel

Urban and rural residents

1, serious illness in residents' outpatient department

2, urban and rural residents medical insurance hospitalization outside the city:

Hospitalization due to illness → Family members fill in the examination and approval form for hospitalization outside the city (stamped by the street citizen service center) → approval by the social security handling center in the third district → submission to the social security handling center in the third district after discharge → treatment declaration → treatment review → treatment payment;

3, urban and rural residents medical insurance as a whole regional transfer:

The chief physician issued a summary of the medical records referred to other hospitals → the audit records of the hospital medical insurance office → the treatment audit records of the social security handling center in the third district → the treatment of the social security handling center in the third district after discharge → the treatment payment;

Flexible employment personnel

1, serious illness in flexible employment clinic

2, flexible employment medical insurance hospitalization outside the city:

Hospitalization due to illness → the unit fills in the examination and approval form for hospitalization outside the city → the examination and approval of Xining Medical Insurance Center → the medical insurance center after discharge → the treatment declaration → the treatment review → the treatment payment;

3. Out-of-hospital medical insurance for flexible employees:

The chief physician issued a summary of the medical records referred to other hospitals → the audit records of the hospital medical insurance office → the audit records of Xining medical insurance center → the audit records of medical insurance center → the treatment after discharge → the treatment payment.

Handling materials

Urban workers:

General clinic: medical insurance ic card;

Special clinic:

1. Go to the medical insurance settlement department to receive the Examination and Approval Form for Special Diseases Outpatient Service or download it from Xining Social Insurance website (in duplicate), which will be filled in and stamped by the hospital;

2. Discharge certificate or discharge summary;

Laboratory sheets and checklists related to disease approval;

4, the special disease outpatient examination and approval form.

Urban residents:

1, transfer to hospital: hospitalization related bills, resident social security IC card;

2. Hospitalization in different places:

Discharge certificate, hospitalization invoice, detailed list of hospitalization expenses, copy of Chinese herbal medicine prescription, certificate of medical institution grade, approval form for resettlement in different places, resident social security IC card, and my ID card.

Handling place

1. datong county Social Security Bureau

Address: No.90 Jiefang South Road, Qiaotou Town, datong county

Tel: 27240 18 27240 19

2. Huangzhong County Social Security Bureau

Address: No.37 Tuanjie South Road, lushaer town, Huangzhong County

Tel: 2230466

3. Huangyuan County Social Security Bureau

Address: No.30 Beitaoji, Xiguan Street, Chengguan Town, Huangyuan County.

Tel: 74 10700

Xining medical insurance reimbursement scope

Medical insurance expenses are not reimbursed:

(1) Define the medical expenses paid by the industrial injury insurance fund;

(2) Traffic accidents (except the relevant escape certificate issued by the public security traffic management department), accidents, medical accidents, etc. This is obviously the responsibility of a third party;

(3) It should be borne by public health;

(4) Going abroad for medical treatment;

(5) Other expenses that shall not be paid according to laws and regulations.

Proportion of medical insurance reimbursement in Xining in 2020

Urban workers

Qifubiaozhun:

The hospital level is Grade I: 350 yuan.

The hospital level is Grade II: 550 yuan.

The level of the hospital is Grade III: 750 yuan.

The reimbursement ratio is:

The level of the hospital is Grade I: 85% of employees and 90% of retired employees;

The level of the hospital is Grade II: 80% of employees and 85% of retired employees;

The level of the hospital is three levels: 75% of employees and 80% of retired employees;

Tips: During the year, the minimum threshold for the second hospitalization was reduced by 100 yuan, and the 50 yuan was reduced again for the third hospitalization. The reimbursement ratio remains unchanged, and the employee medical insurance cap line is 220,000 yuan.

1, the individual pays for treatment items:10%;

2. Individuals pay disposable medical materials first:10%;

3. Individuals pay for oral medical materials first: 20%;

4. The proportion of advance payment for individual patients who go abroad for medical treatment: 10%.

Medical assistance for serious diseases

On-the-job employees are paid 55% by the serious illness relief fund, and medical institutions, employers and individuals each bear15%;

70% of the serious illness medical expenses of retirees are paid by the serious illness relief fund, and medical institutions and individuals bear 15%.

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Reimbursement of hospitalization medical expenses:

Transfer to hospital: the total hospitalization expenses 10%, after deducting the hospitalization deductible line 1.500 yuan, the expenses within the policy scope are reimbursed according to the reimbursement standard of tertiary medical institutions, and the reimbursement ratio is 70%.

Rural resident

1, outpatient fee: 40 yuan per person per year;

2. Hospitalization expenses:

Qifubiaozhun: provincial hospital 500 yuan, municipal hospital 350 yuan, district hospital 100 yuan, township hospital 50 yuan;

Reimbursement ratio:

After deducting Qifubiaozhun, medical and drug expenses of self-funded items:

Provincial reimbursement 60%, municipal reimbursement 70%, district reimbursement 70%, township hospitals reimbursement 90%.

Payment standard of medical insurance in Xining in 2020

Payment ratio

The proportion of medical insurance payment in Xining is 2% for individuals and 6% for units.

Payment base

The upper and lower limits of medical insurance payment base in Xining are adjusted to 19 134 yuan/month and 3827 yuan/month respectively.