What is the upper limit of medical insurance reimbursement?

The upper limit of medical insurance reimbursement is

Maximum reimbursement amount of medical insurance for urban residents

Outpatient reimbursement: 2,000 yuan

Reimbursement for hospitalization: 6,543,800 yuan+7,000 yuan

Maximum reimbursement amount of medical insurance for urban workers

Outpatient reimbursement: 20,000 yuan

Hospitalization reimbursement: 300,000 yuan

Supplementary explanation:

1, and the maximum reimbursement amount refers to the accumulated payment in a medical insurance year.

2. The maximum reimbursement limit of medical insurance for urban workers is 300,000 yuan, including 654.38+million yuan for the basic medical insurance pooling fund and 200,000 yuan for the accumulated large mutual fund.

Matters needing attention in medical insurance reimbursement

1. When the insured is admitted to or discharged from the hospital, they must go through the registration formalities at the medical insurance management window of the designated medical institution with the medical insurance card. If you need to be hospitalized, you need to pay a medical deposit first, and pay more and less after discharge.

2. If the insured person needs to be referred or transferred due to illness, he shall submit the referral opinions agreed by the attending physician of the hospital, and the unit where he works shall fill in the application form, report to the municipal (district) social security agency for approval and go through the referral (hospital) procedures. Among them, the referral is limited to provincial specialized hospitals, and the expenses need to be paid in advance. The reimbursement standard should be 10% first, and then the reimbursable amount should be calculated according to local regulations.

3. After discharge, the hospital will calculate the amount of medical insurance reimbursement and personal payment according to relevant policies. The amount of medical insurance reimbursement can be directly reimbursed at the hospital medical insurance settlement office, and the part paid by individuals needs to be settled by the insured.

4. The standard part of the deductible line for pooling funds after hospitalization will be different according to different local policies. Under normal circumstances, based on 10% of the average annual salary of employees in this city last year, the medical expenses for multiple hospitalizations are accumulated in a basic medical insurance settlement year.

Legal basis:

Measures of the central government for the administration of medical assistance subsidy funds

Twenty-ninth serious illness hospitalization medical expenses, according to the following methods to pay:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.

Thirtieth medical expenses below Qifubiaozhun and above the maximum payment limit shall not be paid by the overall fund.

Thirty-first basic medical insurance fund to pay part of the cost of diagnosis and treatment projects and class B drugs list, the proportion of individual pays, determined by the provincial people's government.

Thirty-second medical expenses of class A infectious diseases such as cholera and plague shall be paid by the overall fund. The medical expenses of explosive and epidemic infectious diseases confirmed by the administrative department of health shall be solved by the people's government.

Article 33 State civil servants and other qualified personnel shall, on the basis of participating in basic medical insurance, implement medical subsidies.