How the medical insurance reimbursement ratio is stipulated

Suzhou medical insurance reimbursement ratio believe that many of the participants in the Suzhou are not particularly understand, in this special to explain to you Suzhou medical insurance reimbursement ratio in the end how to account for. The first thing you need to do is to get a good idea of what you're getting yourself into, and you'll be able to do that with the help of your own personal computer.... To learn more about the Suzhou medical insurance reimbursement ratio is how the knowledge of the provisions, follow me together to see it.

1. General outpatient medical expenses (excluding outpatient specific program medical expenses) that meet the provisions of the Suzhou health insurance insurance settlement will be paid from the individual account first. After the personal account is used up, each settlement year (April to March of the following year), active employees (including flexible employment participants, "co-insurance" personnel) personal responsibility for 600 yuan, retirees personal responsibility for 400 yuan, in the 2500 yuan (excluding the amount of the above deductible) within the limit of the local supplementary medical insurance co-ordination fund according to the proportion of settlement. The local supplementary medical insurance fund will settle the payment according to the proportion. Among them, the outpatient expenses incurred by using the Social Insurance Card at the designated community health service stations (centers), outpatient clinics (clinics), unit health clinics and township hospitals in the urban area of class B and above shall be settled according to the standard of 70% for active employees and 80% for retired staff; the outpatient expenses incurred at other designated medical institutions of class B and above in the urban area and designated retail pharmacies shall be settled according to the standard of 60% for active employees and 70% for retired staff. The standard settlement.

2, Suzhou health insurance participants each hospitalization, the starting standard within the medical costs borne by the individual, can also be used in previous years to offset the amount of personal account balance.

(1) Suzhou health insurance participants in the billing year (April to March) the first hospitalization of the starting standard according to the different levels of hospitals were determined, municipal and municipal hospitals: in-service employees (including flexible employment participants, "co-insurance" personnel, the same below) 800 yuan, retirees 700 yuan; district (county) hospitals, specialty hospitals: 800 yuan, 700 yuan, retirees 700 yuan, retirees 700 yuan. District (county) level hospitals, specialized hospitals: 600 yuan for active employees, 500 yuan for retirees; townships and other grass-roots hospitals: 400 yuan for both active employees and retirees.

(2) The starting standard for the second hospitalization in the same year is 50% of the starting standard for the first hospitalization; the starting standard for the third or more hospitalizations is 200 RMB.

(3) If the hospitalization is more than 180 days consecutively, the hospitalization will be settled once every 180 days, and the part of the hospitalization exceeding 180 days will be treated as a re-hospitalization.

(4) Where the city's Guangji Hospital, Psychiatric Rehabilitation Hospital, Hi-tech Zone Ankang Hospital, Taicang Ankang Hospital, diagnosed as psychiatric hospitalization of the insured, the hospitalization costs incurred in line with the provisions of the health insurance settlement does not set a starting standard, and is directly in accordance with the hospitalization of the settlement of the settlement of the section of the payment method.

(5) If the condition of the patient requires continuous hospitalization within the city, he can go to the Municipal Social Security Center with the settlement vouchers and invoices to be discharged from the hospital and calculate the starting payment standard of the higher level hospitals. We hope you will continue to give us your valuable suggestions and comments on Suzhou Health Insurance.

What is the reimbursement rate for hospitalization for major illnesses under Suzhou Health Insurance?

In order to improve the overall medical protection and health level of the insured, and to promote the construction of a harmonious society, the 66th executive meeting of the municipal government studied, and is now adjusting the medical insurance policy of Suzhou urban area in the year of 2007, and puts forward the following opinions:

I. Suzhou medical insurance increases the amount of retiree's outpatient personal account

Retirees 70 years of age increased by 80 yuan, from 660 yuan per person per year to 740 yuan; 70 years of age or older (including 70 years of age) increased by 100 yuan, from 730 yuan per person per year to 830 yuan.

Two, Suzhou health insurance to improve the level of protection of family hospital beds

family hospital beds each time (within 180 days) starting standard from 500 yuan to 400 yuan, more than the starting standard in line with the health insurance settlement range of costs within 3000 yuan, the integrated fund settlement ratio from 80% to 85%; has been applied for a home hospital beds Participants can be reimbursed in installments within 180 days in accordance with the above provisions.

Three, Suzhou health insurance to improve the level of treatment of urban residents

(a) reduce the urban residents hospitalization starting standard

adjustment of urban residents hospitalization starting standard: third-class hospitals from 1,000 yuan down to 800 yuan, the second-class hospitals from 800 yuan down to 600 yuan, first-class hospitals from 600 yuan down to 400 yuan. The first level of hospitals from 600 yuan to 400 yuan.

(B) adjust the urban residents health insurance financing standards

Suzhou health insurance financing standards are adjusted to: urban residents individual contributions from 100 yuan to 200 yuan, the financial subsidies from 250 yuan per person to 350 yuan; 60 years of the reduction of retired personnel by the unit at a standard of 1500 yuan per person, a one-time payment to the social security agency, the original unit outpatient medical fees are no longer issued; the land requisition maintenance personnel by the social security agency, the original outpatient medical fees are no longer issued; the land requisition maintenance personnel by the social security agency, the original outpatient medical fees are not issued. The outpatient medical fee of 20 yuan per month issued by the social security agency for the maintenance of expropriated land will be stopped, and the social security agency will transfer the fee directly to the residents' medical insurance fund; the medical insurance fee for the low-income, low-income marginal, special hardship worker families and residents with severe disabilities who have completely lost their ability to work or have lost most of their ability to work will be borne by the government. The elderly urban residents who do not have medical insurance can participate in the urban residents' medical insurance, and the medical insurance fee is paid in full by the individual.

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