Hangzhou social security medical how to reimbursement ratio

Medicare is a policy formulated by the state to protect the rights and interests of workers, for people who have to pay medical insurance should know more. What is the scope of medical insurance reimbursement? The following is the latest Hangzhou employee health insurance reimbursement conditions, Hangzhou health insurance reimbursement materials and process hope to help you!

About 2016 Hangzhou medical insurance reimbursement, from the point of view of the protection of the population, the implementation of the new Measures will cover the employees (retirees), urban and rural residents (college students, children, the elderly) and other all groups of people, to achieve the goal of everyone enjoys medical insurance. Currently, there are more than 2,000 health insurance designated institutions in Hangzhou city, from tertiary medical institutions to community service centers, making it more convenient for insured people to seek medical treatment and purchase medicines.

What is the reimbursement rate of Hangzhou medical insurance in 2016? The latest Hangzhou medical insurance reimbursement scope includes what? The hospitalization starting standard above to 20,000 yuan (including), in the third level of medical institutions, 76% before retirement; in the second level of medical institutions, 80% before retirement; in other medical institutions, 84% before retirement; in community health service institutions, 86% before retirement. 20,000 yuan (including), in the third level of medical institutions, 82% before retirement; in the second level of medical institutions, 85% before retirement; in the second level of medical institutions, 85% before retirement; in the second level of medical institutions, 85% before retirement; in the second level of medical institutions, 85% before retirement. 85% before retirement; 88% before retirement if incurred in other medical institutions; 90% before retirement if incurred in community health service organizations. more than $40,000 to $180,000 (inclusive), 88% before retirement if incurred in tertiary medical institutions; 90% before retirement if incurred in secondary medical institutions; 92% before retirement if incurred in other medical institutions and community health service organizations. more than $180,000 , to be borne by both the critical illness Medicaid funds and the individual***, with the percentage borne by the critical illness Medicaid funds being 88% for tertiary care organizations; 90% for secondary care organizations; and 92% for other health care organizations and community health service organizations.

2016 Hangzhou health insurance reimbursement standards, health insurance reimbursement of new policies

Reimbursement ratio

Outpatient treatment:

In a settlement year, the basic medical insurance participants in line with the scope of the general outpatient medical expenses incurred in the scope of the medical insurance expenditure, the first by the personal account of the current year's funds to pay for the current year's funds, personal account of the current year's insufficient funds to pay for the personal responsibility The starting payment standard for an outpatient clinic is 1,000 yuan. Outpatient starting standard above the part of the medical fee, the individual to bear the proportion of: in the third level of medical institutions to bear 24%; in the second level of medical institutions to bear 20%; in other medical institutions to bear 16%; in the community health service institutions to bear 14%.

Hospitalization treatment:

1. A hospitalization starting standard is borne, specifically: 800 yuan for third-level and corresponding medical institutions (hereinafter referred to as third-level medical institutions), 600 yuan for second-level and corresponding medical institutions (hereinafter referred to as second-level medical institutions), and 300 yuan for other medical institutions and community health service institutions.

2. The proportion to be borne by the Coordinated Fund is as follows:

76% of hospitalization above the starting standard up to RMB 20,000 (inclusive), if it occurs in a tertiary medical institution, 76% of the total amount of hospitalization before retirement; 80% of the total amount of hospitalization in a secondary medical institution, 80% of the total amount of hospitalization in a secondary medical institution, 84% of the total amount of hospitalization in other medical institutions, and 86% of the total amount of hospitalization in a community health service institution before retirement.

More than $20,000 to $40,000 (inclusive), 82% before retirement if incurred at a Level III medical facility; 85% before retirement if incurred at a Level II medical facility; 88% before retirement if incurred at another medical facility; and 90% before retirement if incurred at a community health service facility.

More than $40,000 to $180,000 (inclusive), 88% before retirement if incurred in a tertiary care organization; 90% before retirement if incurred in a secondary care organization; and 92% before retirement if incurred in other health care organizations and community health service organizations.

More than 180,000 yuan, by the major diseases medical subsidy funds and personal **** the same, of which the major diseases medical subsidy funds to bear the proportion of: 88% of the third-level medical institutions; second-level medical institutions, 90%; other medical institutions and community health service institutions, 92%.

Hangzhou health insurance reimbursement ratio

Warm tips: If you have any questions, you can also call the labor security consulting services line 12333 ext. 1-city labor security consulting services line manual service (Monday to Friday 8:45-12:00, 13:30-17:00, except holidays) for consultation.

Reimbursement Scope

(a) Expenses for western medicines, proprietary Chinese medicines and Chinese herbal medicines listed in the basic medical insurance drug catalogs stipulated by the state and provinces.

(2) Expenses listed in the basic medical insurance diagnosis and treatment programs stipulated by the state and province.

(3) Fees listed in the standards of basic medical insurance medical service facilities stipulated by the state, province and the city.

(4) Fees for homemade preparations of designated medical institutions that are included in the reimbursement scope of basic medical insurance in accordance with the regulations.

(v) Medical expenses incurred in non-designated medical institutions in the city or non-profit medical institutions outside the city for medical treatment due to emergencies that are eligible for reimbursement under basic medical insurance.

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