Proportion of reimbursement for medical treatment in different places in Baoying Medical Insurance

Medical insurance can be reimbursed locally or in other places, and the reimbursement ratio is the same. The specific reimbursement ratio needs to be determined according to the type of medical insurance. 1. How to reimburse the baby for medical insurance in different places 1, and the proportion of outpatient reimbursement. There is no deductible line in the general outpatient service, and all insured residents enjoy the treatment of the general 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. 3. There may be "second reimbursement" after the "second reimbursement". The medical expenses incurred by the insured residents in a single hospitalization belong to the part paid by the basic medical insurance fund for urban residents. After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to the excess part according to the proportion of 55%. After the basic medical insurance payment and "second reimbursement", the annual accumulated hospitalization medical expenses of the insured residents (including the compliant and reasonable self-funded part) exceed 25,000 yuan, and the excess part is "reimbursed" again by the serious illness insurance fund according to the proportion of 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan. 4. Residents who participate in medical insurance for urban residents in our city can be reimbursed up to 370,000 yuan per year. The annual payment limit of basic medical insurance is 6.5438+0.2 million yuan, and the payment limit of serious illness insurance is 250,000 yuan. Therefore, Enoch Finance found that the insured can be reimbursed up to 370,000 yuan per year. Second, the reimbursement process of medical insurance in different places 1. Receive or download the "Declaration Form for People Working and Living in Different Places of Basic Medical Insurance in this Municipality" (hereinafter referred to as the "Declaration Form") on the social security website; 2, according to the provisions of the fill in, and by the foreign social insurance (medical insurance) agencies stamped "declaration form"; 3 will fill out the "declaration form" back to the social insurance agency responsible for the division of labor for review and confirmation. Need to apply for a medical card in different places in the province, with the "declaration form" after examination and confirmation to the municipal social security center audit department for registration, and then to the social security card management department for the card making procedures in different places in the province; 4. The insured person's personal social security card cannot be used after filing; If the insured person returns for medical treatment, he should go to the municipal social security agency for cancellation of medical registration, and his personal social security card can be used in designated medical institutions from the next day; 5. Implement the principle of reporting changes but not reporting. Third, the scope of medical insurance reimbursement in different places is divided into internal medicine and external hospitals, and cannot be reported outside medical insurance. All you need is hospitalization procedures, medical list and personal medical insurance card. The reimbursement time is 3-6 months. 1, outpatient (emergency) large Medicaid maximum payment limit is 5500 yuan; Qifubiaozhun is 800 yuan, an on-the-job employee, 700 yuan, a retiree over 60 and under 70, and 600 yuan, a retiree over 70. Reimbursement ratio: the reimbursement ratio of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 65%; The reimbursement rate of first-class hospitals is 75%. 2, hospitalization within a medical year, the first hospitalization Qifubiaozhun, tertiary hospital 1700 yuan, secondary hospital 1 100 yuan, first-class hospital 800 yuan. Secondary and above hospitalization: tertiary hospital 500 yuan, secondary hospital 350 yuan, and primary hospital 270 yuan. Reimbursement ratio: 85% of employees with a minimum threshold of 55,000 yuan will be reimbursed; Retirees are 90%. For medical expenses ranging from 55,000 yuan to 6,543.8+0.5 million yuan, the reimbursement ratio of employees and retirees is 80%. Old workers who took part in the work before the founding of the People's Republic of China were reimbursed 95% in tertiary and secondary hospitals and 97% in primary hospitals. 3. The maximum payment limit for large medical assistance is 300,000 yuan, and the reimbursement rate for employees and retirees is 80%. According to the law, we can know that the reimbursement rate of medical insurance in different places is generally 70% to 95%, and the reimbursement of medical expenses in different proportions should be confirmed and handled according to the actual situation.

Legal objectivity:

Article 28 of the Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business 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.