Employee medical insurance reimbursement ratio
First, hospitalization reimbursement
1, minimum payment standard: first-class 200 yuan, second-class 440 yuan, third-class 880 yuan;
2. Reimbursement limit: 32,000 yuan/year for the overall medical insurance fund and 500,000 yuan/year for the mutual fund for large medical expenses.
3. Reimbursement ratio:
A medical insurance pooling fund: 90% for the first level, 87% for the second level, 85% for the third level and 95% for retirees;
B mutual fund for large medical expenses: 100%.
1, if the overall fund pays more than 32,000 yuan, it is in line with the reimbursement regulations of large medical expenses mutual fund.
2. If the insured is hospitalized in the primary and secondary community health service institutions, the hospitalization deductible standards are 160 yuan/time and 400 yuan/time respectively.
3. For multiple hospitalizations within one year, the hospitalization deductible will be reduced by 1 0% on the basis of the above standards for each increase of1time; After the downward adjustment, tertiary hospitals should be no less than 620 yuan/time, secondary hospitals should be no less than 260 yuan/time, and primary hospitals should be no less than 100 yuan/time.
4. The proportion of reimbursement for medical expenses of Chinese medicine and Chinese medicine diagnosis and treatment projects in medical insurance coverage for hospitalization and special disease clinics in Chongqing Chinese medicine medical institutions increased by 2 percentage points.
Second, the special disease outpatient reimbursement
1, minimum payment standard: first-class 200 yuan, second-class 440 yuan, third-class 880 yuan;
2. Reimbursement limit: 32,000 yuan/year for the overall medical insurance fund and 500,000 yuan/year for the mutual fund for large medical expenses;
3. Reimbursement ratio:
A. Overall planning of medical insurance fund: the cost of anti-rejection drugs for patients with malignant tumor radiotherapy/chemotherapy/analgesia, dialysis treatment for patients with renal failure and organ transplantation is 90%, and others are 80%;
B mutual fund for large medical expenses:100%;
4, special disease payment limit and hospitalization combined calculation, of which the annual outpatient payment limit for severe prostatic hyperplasia is 1000 yuan.