In this issue, I'll show you: reimbursement standards for medical insurance hospitalization for employees and retirees in Sichuan!
First, the basic situation of medical insurance for employees in Sichuan Province
By the end of 2020, the number of urban workers' medical insurance participants in Sichuan Province was18.75 million, including13.64 million employees and 510.00 million retirees. The total income of the basic medical insurance (including maternity insurance) fund in Sichuan Province is 77.9 billion yuan, the total expenditure is 58.4 billion yuan, and the accumulated balance of the medical insurance fund is 146 1000 billion yuan.
Generally speaking, the income of medical insurance fund for employees in Sichuan Province is greater than the expenditure, and the fund is relatively substantial.
II. Hospitalization treatment of medical insurance for employees in Sichuan Province
Regarding the hospitalization treatment of medical insurance for employees in Sichuan Province, there is a slight difference among the cities under its jurisdiction, and the latest hospitalization treatment of medical insurance for employees in each city shall prevail. Let's take Chengdu as an example and make a concrete analysis for reference only.
1. Qifubiaozhun
(1) Level-I hospital: the minimum payment standard is 200 yuan, and the reimbursement rate is 92%.
(2) Secondary hospital: The minimum payment standard is 400 yuan, and the reimbursement rate is 90%.
(3) Tertiary hospitals: the minimum payment standard is 800 yuan, and the reimbursement rate is 85%.
(4) Community service center of township hospitals: the minimum payment standard is 160 yuan, and the reimbursement rate is 95%.
It should be noted that on the basis of the above standards, when you reach the age of 50, the reimbursement rate will increase by 2%; At least 70 years of age, an increase of 6%; At least 80 years of age, an increase of 8%; At least 90 years old, increased by 10%.
However, with the increase of age, the reimbursement rate of medical expenses shall not exceed 100%.
For example:
Uncle Wang, a native of Chengdu, Sichuan, is 65 years old this year. I was hospitalized in a secondary hospital in Chengdu and spent 30,000 yuan on medical expenses, of which 1 10,000 yuan was beyond the scope of medical insurance reimbursement. So how much medical expenses can Uncle Wang reimburse when he leaves the hospital?
Uncle Wang reimbursed medical expenses: (30000-10000-200) * (90%+4%) =18612 yuan.
2. Medical insurance reimbursement for serious illness
For example:1-30,000 yuan, if the payment is made according to the payment rate of 0.5%, the reimbursement ratio will be 40%; According to the 1% payment rate file, the reimbursement rate is 80%.
It should be noted that the so-called mutual aid for serious illness does not necessarily require serious illness to be reimbursed. As long as it is in the medical insurance catalogue, after the employee's medical insurance reimbursement, the rest who meet the medical insurance reimbursement can also be reimbursed through mutual aid for serious illness.
Write at the end:
In Chengdu, Sichuan, employees can continue to enjoy lifelong medical insurance benefits after they have paid 15 years or accumulated contributions for 20 years. Compared with other provinces, this standard of minimum payment period for medical insurance is quite acceptable. For many flexible employees, it is also relatively easy to achieve. Like Chengdu Medical Insurance!
What do you think of the reimbursement rate and payment period of medical insurance?