What is the reimbursement ratio of Hubei medical insurance in different places?

Proportion of medical insurance reimbursement in different places in Hubei

Medical insurance in different places is the focus of attention in recent years, so what is the reimbursement ratio of medical insurance in different places in Hubei? Is everyone clear? Come and have a look today!

Li Jiachuan, who lives in Xianning 20 15, was discharged from Wuhan Army General Hospital. What makes him happy is not only the recovery of his body, but also the original cumbersome medical insurance reimbursement procedures no longer exist. "It is really convenient to directly brush the medical insurance card for settlement without going back for reimbursement."

By the end of 20 14, the province had fully realized the remote network settlement of medical insurance. In other words, all insured persons in the province can seek medical treatment in 50 designated hospitals in the province as long as they hold social security cards or ID cards, and settle accounts immediately. This discharge, Li Jiachuan only needs to settle part of the expenses that the individual should bear, and the rest will be settled directly by the medical insurance agency and the designated hospital.

Li Jiachuan, 68, was diagnosed with liver cancer in Xian 'an Hospital last September. After consultation with family members, he went to Wuhan Army General Hospital for interventional treatment of liver cancer on October 8, 20 15/KLOC-0, and then went through the discharge formalities. "A total of * * * spent more than 22000, I made 5700. It was done on the spot, and it took only a quarter of an hour before and after, very fast! " Legend of the Li family.

According to statistics, in 20 15 years, 35,300 people from different cities (states) in our province went to designated medical institutions in Wuhan for medical treatment, with an immediate settlement rate of 97.2%, a total medical expense of 940 million yuan, and a reimbursement rate of 66.2% within the policy scope.

According to the legend of the Li family, four years ago, he went to Wuhan to see a doctor. He not only paid for it himself, but also had a lot of trouble when he returned to Xianning with the bill. "Either he didn't get all the information, or he covered a chapter less and tossed it back and forth several times, which was time-consuming and laborious."

In 20 15, the provincial government listed the real-time settlement of medical treatment in different places in the province as one of the practical commitments for the people. According to the flow of medical personnel in different places, the professional characteristics and regional distribution of medical institutions, the Provincial People's Social Welfare Department has identified 50 designated medical service institutions in the province to provide more efficient and convenient medical services for medical personnel in different places. The human and social departments have also established an online monitoring system for medical treatment in different places at the provincial level. Through the unified medical insurance drug list, medical treatment (materials) items, service facilities standards, disease code database and medical insurance doctor database in the province, online monitoring of medical treatment services in different places in the province can be realized according to monitoring rules, so as to prompt and control doctors' violations in time and ensure the safe operation of the fund. "By the end of 20 15,' online settlement' will cover different designated medical institutions in the province and benefit more patients." The Provincial People's Social Welfare Department said.

Reimbursement proportion and process

The following information must be brought when submitting the reimbursement form: 1. Original ID card or social security card; 2. The original disease diagnosis certificate issued by the designated medical institution; 3 outpatient medical records, inspection, test results report and other medical information; 4. Original receipt of outpatient charges of medical institutions with unified finance and taxation; 5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors; 6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods; 7. If it is an agent, you need to provide the original ID card of the agent.

Bring all the above information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it can be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.

The reimbursement process and matters needing attention of hospitalization medical insurance;

1. When entering or leaving the hospital, you must go through the registration formalities at the medical insurance management window of each designated medical institution with a medical insurance IC card. When in hospital, the individual pays the deposit of medical expenses in advance, and pays more and less after discharge. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be used to go through the hospitalization formalities at the medical insurance management window the day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves.

2. After the insured is hospitalized, the deductible line of the overall fund is different from place to place, which is generally 10% of the average annual salary of employees in the whole city in the previous year. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3. If the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities with the approval of the medical insurance management department of the designated medical institution.

The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When the designated medical institutions are discharged from the hospital, the designated medical institutions will calculate the reimbursement amount of medical insurance and the amount that individuals should pay. The reimbursement amount will be settled by the designated medical institutions and urban social insurance agencies, and the amount that individuals should pay will be settled by the designated medical institutions and the insured.

Further reading: Hubei will unify urban and rural medical insurance from next year, and the medical treatment in different places in the province will be settled immediately.

The General Office of Hubei Provincial Government recently issued the "Work Plan for Integrating the Basic Medical Insurance System for Urban and Rural Residents in Hubei Province" (hereinafter referred to as the plan), which requires that the medical insurance for urban residents and the new rural cooperative medical system be merged in 20 17, and a unified medical insurance system for urban and rural residents should be implemented, and the proportion of hospitalization reimbursement should be unified at around 75%.

According to the plan, the organization, functions, personnel integration and asset transfer will be completed before the end of August this year; Before the end of September, study and formulate policies related to medical insurance for urban and rural residents; Before the end of the year, the audit of urban residents' medical insurance fund and new rural cooperative medical care fund, the development of urban and rural residents' medical insurance information system and the docking with medical institutions will be completed; In 20 17, the province implemented a unified medical insurance system for urban and rural residents.

In the management system, the management functions of the new rural cooperative medical system undertaken by the health and family planning department and the medical insurance management functions of urban residents undertaken by the human resources and social security department are merged and unified into the human resources and social security department. The organization, establishment, personnel and funds of the health and family planning departments related to the new rural cooperative medical system shall be integrated into the Ministry of Human Resources and Social Security. From institutional integration to the operation of the new system, urban residents' medical insurance and the new rural cooperative medical system are managed in a unified way, running separately and accounting separately. During the period of system integration, the medical insurance for urban residents and the new rural cooperative medical policy will not be adjusted.

The integrated medical insurance system covers the existing urban residents' medical insurance and all the insured persons of the new rural cooperative medical system, and continues to implement the financing method combining individual contributions and government subsidies, and encourages collectives, units or other social and economic organizations to give support or funding. In addition, it is necessary to unify the protection treatment, including the minimum compensation standard, reimbursement ratio and maximum compensation limit. And the proportion of hospitalization expenses within the policy scope will remain at around 75%.

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What is the proportion of medical insurance reimbursement?

The first is the proportion of urban medical insurance reimbursement. Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.

1, students, children. In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

2. At least 70 years old and above. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

3. Other urban residents. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Second, the proportion of employee medical insurance reimbursement. Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. The following is an explanation of the proportion of employees' medical insurance in Beijing.

After receiving medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed, and the reimbursement rate is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.

No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 700 yuan can reimburse 50%, that is, 350 yuan.

If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 yuan.

The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.

The medical treatment items that employees' basic medical insurance will not pay are mainly those that are clinically unnecessary and have uncertain curative effects, and those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other categories such as infertility treatment.