Proportion of reimbursement for medical insurance and new rural cooperative medical system for urban and rural residents

The reimbursement ratio of medical insurance for urban and rural residents and the new rural cooperative medical system is as follows:

1, 300 yuan, the deductible line of the first-class hospital for urban and rural residents' medical insurance, with the reimbursement rate of 60%;

In 400 yuan, the deductible line of secondary hospitals, the reimbursement rate of expenses below 6,000 yuan is 60%, and the reimbursement rate of expenses above 6,000 yuan is 80%;

In the deductible line of tertiary hospitals in 600 yuan, the reimbursement rate of expenses below 6,000 yuan is 65%, and the reimbursement rate of expenses above 6,000 yuan is 80%;

2. The reimbursement rate for outpatient service of the new rural cooperative medical system is 60% for village clinics and hospitals, 40% for town hospitals, 30% for secondary hospitals and 20% for tertiary hospitals, and the reimbursement limit for outpatient service of town-level cooperative medical system is 5,000 yuan/year;

3, the new rural cooperative medical system in different places for reimbursement of township hospitals deductible line 100 yuan, reimbursement ratio of 90%;

The deductible line of county-level designated hospitals is 200 yuan, and the reimbursement rate is 82%;

The deductible line of municipal designated hospitals is 500 yuan, and the reimbursement rate is 65%;

4, the new rural cooperative medical system hospitalization reimbursement town hospitals 60%, secondary hospitals 40%, tertiary hospitals 30%;

Serious illness reimbursement is 55%-60% in tertiary medical institutions, 55% in provincial tertiary medical institutions, 70% in children with congenital heart disease and 70% in lung cancer and other diseases.

The scope of medical insurance reimbursement for urban and rural residents:

1. Basic medical insurance reimbursement: covering medical expenses, medical expenses, inspection fees, etc. The insured seeks medical treatment due to illness;

2. Reimbursement of critical illness insurance: reimbursement of high medical expenses provided for the insured suffering from specific critical illness;

3. Outpatient co-ordination reimbursement: some areas implement outpatient co-ordination and reimburse a certain proportion of outpatient expenses;

4. Outpatient reimbursement for chronic diseases: a certain proportion of outpatient expenses for patients with chronic diseases are reimbursed;

5. Reimbursement of hospitalization expenses: The medical expenses incurred by the insured during hospitalization shall be reimbursed according to the prescribed proportion.

To sum up, there are differences in the reimbursement ratio between urban and rural residents' medical insurance and the new rural cooperative medical system. The reimbursement rate of medical insurance for urban and rural residents varies according to hospital level and expenses, and the reimbursement rate of new rural cooperative medical system varies according to hospital level and reimbursement in different places. The proportion of outpatient reimbursement of the new rural cooperative medical system is also different according to the level of the hospital, and there is a limit. The proportion of reimbursement for hospitalization of the new rural cooperative medical system is also different according to the hospital level and disease type, and the proportion of reimbursement for serious illness is also different.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.