The reimbursement ratio and qifubiaozhun of medical insurance in Hangzhou

The proportion of medical insurance reimbursement in Hangzhou includes two aspects:

1, basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%;

2. Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

The qifubiaozhun for medical insurance reimbursement is:

The deductible line of first-level and below medical institutions is 700 yuan, the deductible line of second-level medical institutions is 900 yuan, the deductible line of municipal third-level medical institutions is 1 000 yuan, and the deductible line of third-level medical institutions is 1, 300 yuan. Residents' medical insurance pooling fund qifubiaozhun for 200 yuan, 200 yuan and the following parts, paid by individual residents; For the above part of 200 yuan, 50% will be reimbursed by the overall fund and 50% will be borne by the individual. According to different diseases, the maximum annual cumulative reimbursement limit is set.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

Medical insurance reimbursement standard:

1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;

2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio 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 the first-class hospital, and the reimbursement rate is 60%;

3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.

To sum up, the medical insurance deductible line is the deductible standard of "basic medical security". According to the basic medical insurance system reform principle that "the medical insurance fund and the insured individuals share the hospitalization expenses", the insured person's hospitalization expenses within the scope of the Catalogue of Basic Medical Insurance in designated medical institutions will actually bear part, and then be paid by the medical insurance fund according to the prescribed proportion. The standard of the amount of hospitalization medical expenses paid by individuals first is the "deductible line" for the medical insurance fund to pay the insured's hospitalization medical expenses. The hospitalization expenses below Qifubiaozhun shall be borne by the patient.

Legal basis:

Article 28 of People's Republic of China (PRC) 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.