Proportion of medical insurance reimbursement for urban and rural residents in Foshan

Medical insurance reimbursement ratio: 1. There is no deductible line for outpatient reimbursement, and all insured residents enjoy the treatment of ordinary outpatient service. Within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan. 2. The proportion of hospitalization reimbursement The longer the continuous insurance period, the greater the proportion of reimbursement. The proportion of hospitalization reimbursement of the medical insurance fund will increase by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative amount will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

Legal objectivity:

The reimbursement rate of medical insurance for urban residents in Shanxi Province is 1. Proportion of reimbursement for urban residents: level 1 hospital: 85 level 2 hospital: 70 level 3 hospital: 60 emergency hospitalization: 50 referral to foreign level 3 hospital: 55 general outpatient service. The reimbursement rate for medical expenses above Qifubiaozhun that meet the scope of outpatient co-ordination payment is 50%. 2. Reimbursement ratio of urban workers: less than 5,000 yuan (including 5,000 yuan), individual pays 0/5% for first-class hospitals, 0/7% for second-class hospitals and 0/9% for third-class hospitals; 5000 yuan to 15000 yuan (including 15000 yuan), individuals pay 13% in the first-level hospital, 15% in the second-level hospital and17% in the third-level hospital; If the individual pays more than RMB 15000, the first-level hospital pays 1 1%, the second-level hospital pays 13%, and the third-level hospital pays 15%. Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. Legal basis: Article 29 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the medical expenses incurred by the insured shall be paid by the basic medical insurance fund and directly settled by social insurance agencies, medical institutions and pharmaceutical trading units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits. Article 30 of People's Republic of China (PRC) Social Insurance Law The following medical expenses are not covered by the basic medical insurance fund: (1) expenses that should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) 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.