Proportion and scope of social security reimbursement

The reimbursement rate of social security is as follows:

1, residents participate in medical insurance file A (80 yuan per person per year), and the maximum annual payment limit of the fund is 300,000 yuan, and the reimbursement rate of the first-level hospital is 95%, that of the second-level hospital is 75%, and that of the third-level hospital is 65%;

2. For residents who participate in the B-file of medical insurance (per person per year 170 yuan), the maximum payment limit during the fund year is 400,000 yuan, and the reimbursement rate is 95% in the first-class hospital, 85% in the second-class hospital and 75% in the third-class hospital. Residents' medical insurance level is different, and the reimbursement ratio will be different.

3. The scope of medical insurance reimbursement: medical expenses: auxiliary examination: 200 yuan for various examination expenses such as electrocardiogram, X-ray fluoroscopy, photography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). The elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

The scope of reimbursement is as follows:

The insured in the designated medical institutions and retail pharmacies in the following matters:

(1) expenses are included in the reimbursement scope of the basic medical insurance fund for urban residents: hospitalization expenses; Medical expenses within 7 days before emergency observation and hospitalization;

(2) medical expenses for special diseases in urban residents' outpatient clinics; Other expenses that meet the requirements. Reimbursement ratio: hospitalization reimbursement. Insured persons are hospitalized in tertiary, secondary and primary designated medical institutions, and the reimbursement rates within the scope of medical insurance are 60%, 70% and 80% respectively. A class of low-income severely disabled insured persons increased by10% on this basis;

(3) Special disease outpatient service: After the application is confirmed, you can enjoy 60% to 80% reimbursement treatment below the monthly limit. General outpatient service: The maximum reimbursement limit for a single medical treatment fee is 40 yuan. The maximum reimbursement limit in one year is 160 yuan, of which the maximum reimbursement limit for insured residents aged 60 and above and women aged 55 is 240 yuan.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.