Guangzhou workers health insurance residents health insurance reimbursement ratio

Guangzhou health insurance is divided into urban workers' health insurance and urban and rural residents' health insurance, the two reimbursement ratios are different, as follows:

1, urban workers' health insurance: primary health care institutions: standard: 80%; the implementation of the basic drugs and zero-differential rate sales of Class A drugs: 88%. Other medical institutions and designated specialized medical institutions: 45% without referral; 55% after referral; maximum payment limit of the integrated fund: 300 yuan/person/month.

2. Urban and rural residents' health insurance: minors and school students: 80% of the payment from the integrated fund of the primary selected medical institutions. Residents: 60% of the payment ratio from the coordinated fund of the primary selected medical institutions.

Guangzhou medical insurance reimbursement process:

1, hospitalization with card. Participants with social security card for hospitalization registration, discharge settlement directly for reimbursement procedures.

2. Hospitalization without card. If a participant has to be hospitalized during the period without a card, he/she has to bring a letter of introduction from his/her unit and a copy of his/her admission card to the Urban Employees' Medical Insurance Office of the Municipal Social Security Bureau to issue a certificate of not having a card before he/she can go through hospitalization procedures, and he/she will not be reimbursed when discharged from the hospital until he/she has a card and then goes to the hospital with his/her card to go through the procedures of cost settlement.

3. Prepare materials. Prepare discharge records, medical records, disease diagnosis and other materials, and make sure they are stamped.

4. Submit the reimbursement application. After being discharged from the hospital, bring the materials to the medical insurance reimbursement department to submit the reimbursement application.

5. Medical treatment in other places. Participants with health insurance card to the second level of the Guangzhou Municipal Health Insurance Agency to apply for the record book of medical treatment in a different place, and in a different place to choose one to three basic medical insurance designated medical institutions local hospitals and health insurance institutions need to be in the record book of medical treatment in a different place to review the seal.

In summary, the difference in reimbursement rates between the Guangzhou Employee Health Insurance and the Resident Health Insurance reflects the different positioning and service targets of the two health insurance systems. Employee medical insurance provides a higher level of medical protection, while resident medical insurance provides basic medical protection for a wider range of urban and rural residents.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards for medical service facilities, as well as those for emergencies and salvages, 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.