Qingdao social security reimbursement scope

According to Qingdao Social Medical Insurance Measures promulgated and implemented by Qingdao Social Security Bureau on 20 15, Qingdao residents' social medical insurance includes hospitalization, outpatient serious illness, outpatient co-ordination, accidental injury, medical treatment in different places and long-term care insurance.

Project 1: Hospitalization

1, down payment: 85% for the first-level institution, 80% for the second-level institution and 70% for the third-level institution;

2. Secondary payment: 80% for primary institutions, 70% for secondary institutions and 55% for tertiary institutions;

3. Students and children: 90% in first-level colleges, 85% in second-level colleges and 75% in third-level colleges.

Note: Adult residents are hospitalized in street/town health centers or community service centers where the basic drug system is implemented, and the reimbursement rate is increased by 5%.

Item 2: General outpatient service

1, down payment: 50%, and the maximum reimbursement for 720 yuan within one year;

2. Second-grade payment and children: 40%, and the highest reimbursement for 330 yuan within one year;

3. The proportion of reimbursement for medical expenses incurred by insured residents using essential drugs increased 10%.

Item 3: Serious illness in outpatient department

1, down payment: 80% for the first-level institution, 70% for the second-level institution and 65% for the third-level institution;

2. Secondary payment: 75% for primary institutions, 65% for secondary institutions and 55% for tertiary institutions;

3. Students and children: 90% in first-level colleges, 85% in second-level colleges and 80% in third-level colleges.

note:

1. The reimbursement ratio of designated medical institutions in the community shall be implemented according to the first-class hospitals.

2. The proportion of reimbursement for essential drugs for adult residents in designated medical institutions in the community increased 10%.

3, more than the disease limit standard above the part will not be reimbursed.

Item 4: critical illness medical insurance

1, over-limit subsidy: 80% for first-class residents/children and 70% for second-class residents;

2. Large subsidies: 60% for first-class residents/children and 50% for second-class residents.

note:

1. After the hospitalization and outpatient expenses of designated institutions are reimbursed by the basic medical insurance, the personal burden within the overall planning scope will be included in the reimbursement scope of serious illness medical insurance.

2. The over-limit subsidy exceeds the maximum reimbursement limit of the basic medical insurance fund, and the maximum subsidy limit for one year is 400,000 yuan.

3, large subsidies that accumulated in a year more than serious illness medical insurance Qifubiaozhun above the cost of subsidies, the annual maximum payment limit of 200 thousand yuan.

4, uremia dialysis treatment, organ transplantation anti-rejection treatment, the insured critical illness medical insurance Qifubiaozhun is 3000 yuan, the proportion of subsidies increased 10%.

Item 5: Large medical assistance

1, special drugs and special materials rescue: 70% of the medical expenses incurred by qualified use of special drugs and special materials;

2. Out-of-scope large-scale assistance: coordinating the medical expenses necessary for out-of-scope treatment, with an annual cumulative assistance of 60% exceeding 50,000 yuan. Enjoy special care, subsistence allowances, subsistence allowances for the insured in marginal families, and there is no threshold for large-scale assistance. The maximum annual reimbursement for large-scale assistance is 654.38+10,000 yuan.

3. Medical assistance for special care recipients: eligible low-income family insured persons can also enjoy medical assistance for special care recipients from the civil affairs department according to regulations.

Item 6: Other reimbursement

1, the medical expenses of children's accident outpatient service can be reimbursed by the social medical insurance fund according to regulations.

2, the only child hospitalization, outpatient serious illness to see a doctor, emergency medical expenses, on this basis, the proportion of reimbursement for children increased by 5%.

3, the insured residents in the designated medical institutions in accordance with the family planning policy of medical expenses, according to the provisions of reimbursement.