Q: Is the Suzhou New Rural Cooperative Medical Insurance Card the same as the urban employee medical insurance card, such as the proportion of hospitalization reimbursement? Or what is the maximum?

A: Medical insurance for urban and rural residents (NCMS) and medical insurance for employees enjoy different treatment. Here, I will introduce the hospitalization reimbursement ratio of urban and rural residents' medical insurance (new rural cooperative medical insurance) and employee medical insurance respectively:

First, the hospitalization medical insurance for serious illness of urban and rural residents (the new rural cooperative medical system) is managed by different types of medical institutions, and the medical expenses are paid in stages, and the medical expenses are accumulated during the insurance period.

The specific compensation standards are as follows:

(1) Payment standard for hospitals and health centers (community health service centers) in this district: that is, for eligible hospitalization expenses incurred by insured persons in Xiangcheng People's Hospital and all township health centers in this district during the settlement year, 60% of the expenses above 4,000 yuan (including 4,000 yuan) will be paid, and 80% of the expenses above 4,000 yuan will be paid.

(2) Payment standards of municipal medical institutions: namely, in the First Affiliated Hospital of Suzhou University, the Second Affiliated Hospital, the Children's Affiliated Hospital, the Suzhou Municipal Hospital (the Second Affiliated Hospital, the Third Affiliated Hospital and the Fourth Affiliated Hospital), the Fifth Affiliated Hospital of Suzhou, the Seventh Affiliated Hospital, the Chinese Medicine Hospital, the Guangji Hospital (only for psychiatric treatment), the Suzhou Kowloon Hospital, the First Affiliated Hospital of China People's Liberation Army, and the Guangci Branch of the First Affiliated Hospital of Suzhou University (.

(3) Payment standard for approved transfer to tertiary and specialized medical institutions in other places: 40% of the hospitalization expenses incurred by the insured within the settlement year, including 4000 yuan, and 45% of the hospitalization expenses above 4000 yuan.

(4) The medical expenses for specific items of the insured's serious illness hospitalization and outpatient service are accumulated within one insurance year, and the accumulated actual settlement amount is 6,543,800 yuan+0.2 million yuan.

Part of the medical expenses for the treatment of traditional Chinese medicine, Chinese patent medicine and Chinese herbal pieces will be increased by 5% on the basis of the above settlement payment ratio.

Two, employee medical insurance in the settlement year, the insured workers in designated medical institutions in accordance with the provisions of the hospitalization expenses, paid by the basic medical insurance fund and the insured workers in proportion:

The hospitalization expenses of the insured employees exceed Qifubiaozhun, and the expenses with the highest payment limit of 654.38+10,000 yuan shall be paid by the basic medical insurance pooling fund and individuals in installments according to the accumulated settlement year. Among them, 40,000 yuan (including 40,000 yuan) is paid by the basic medical insurance fund according to the proportion of 90% of employees and 95% of retirees; 40,000 yuan to 654.38+10,000 yuan (including 654.38+10,000 yuan), and the basic medical insurance fund will be paid according to the proportion of 95%. For the accumulated part exceeding 654.38+10,000 yuan, 95% of the large medical expenses are paid by social funds and 5% by individuals.