1, deductible line: 300 yuan, 600 yuan, 200 yuan;

2. The reimbursement rate is 95% for the first-level medical institutions, 90% for the second-level medical institutions and 85% for the third-level medical institutions, of which 90% is paid by the fund for the surgical treatment of malignant tumors, cardiac and brain diseases and liver, kidney and bone marrow transplantation.

3, outpatient specific disease reimbursement ratio:

(1) The reimbursement rate is the same as hospitalization, and there is no deductible. 95% of the first-level medical institutions, 90% of the second-level medical institutions and 85% of the third-level medical institutions (including 90% of serious diseases such as radiotherapy, chemotherapy, hyperthermia and uremia outpatient dialysis treatment) are paid to the quota standard;

(2) The annual quota is divided into three grades, the low-grade quota is 4500-5500 yuan, the middle-grade quota is 45000-45000 yuan, and the high-grade quota is 65438+ 10,000 yuan.

Proportional process of medical insurance reimbursement

1, medical insurance, whether for urban workers or urban residents, must be hospitalized in accordance with the local designated medical institutions approved by the local medical insurance institutions;

2. If you need to go to other medical institutions for treatment, you need to issue a referral certificate to the local community hospital or community health service center or designated medical institutions;

3. If you are hospitalized in a local medical insurance designated medical institution, the hospital will automatically deduct the medical insurance reimbursement at the time of checkout;

4, in the local medical insurance designated treatment but not hospitalized, or radiotherapy, chemotherapy, etc. In hospitals that are not reimbursed, you can bring the official invoice, medical diagnosis, medication list, social security card or medical card issued by the hospital to the medical insurance window of the local administrative service center for reimbursement;

5. Those who have been treated in other medical institutions and have a referral certificate must submit all the treatment invoices, hospital diagnosis certificate, hospitalization certificate, ID card, social security card, medication list and medical records to the medical insurance window where the household registration (medical insurance) is located before 65438+February 3 1 every year.

6. If you don't have a referral certificate, or go to a different place for medical treatment directly (sometimes it is urgent or too far away to issue a referral certificate in time), in this case, you need to issue a proof of residence in the community where you live, such as renting here or living with children. When submitting the reimbursement, bring all the materials in step 5, plus proof of residence.

When will medical insurance take effect after payment?

How long after the medical insurance payment takes effect needs to be judged according to the specific situation, as follows:

1, the effective time of the first basic medical insurance. The following month when the basic medical insurance is insured, and the local tax authorities confirm that the insured has paid the basic medical insurance premium, it will take effect on 1 day of that month. Need to be reminded that before the basic medical insurance comes into effect, the medical insurance of the insured person is the responsibility of the unit;

2, the effective time of the basic medical insurance relationship. If the original unit goes through the formalities for the decline of basic medical insurance benefits in the next month and goes through the formalities for renewal, the basic medical insurance benefits will not be interrupted, and the basic medical insurance premium will be paid to the local tax department from the month of renewal; If payment is interrupted, the basic medical insurance benefits will take effect on the month 1 day when the local tax department collects the basic medical insurance premium of the insured.

3, the basic medical insurance special circumstances. Due to the delay in registration and premium collection, etc. If the insured fails to pay the medical expenses by credit card when seeking medical treatment, he shall show the payment receipt certificate signed and sealed by the local tax department; Due to the delay in making the social security card, the medical expenses after the treatment takes effect shall be settled in the corresponding social insurance agency according to the provisions of medical insurance after being signed and sealed by the business card printing department of the social security agency with the payment receipt voucher of the local tax department and the personal payment voucher.

3. Effective time of commercial medical insurance. The validity period of commercial medical insurance is generally 30 days to 180 days, and some are 1 year.

(1) general hospitalization medical insurance: the effective time is 30 days to 90 days;

(2) Some long-term critical illness insurance: the effective time may reach 90 days, 180 days or even 1 year.

Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC).

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.