Proportion of medical insurance reimbursement for urban and rural residents in Wuhan in 2023
First, general outpatient service.
1. Reimbursement ratio: 50% is paid by the residents' medical insurance fund.
2. Reimbursement amount: annual payment limit of 400 yuan.
3. Qifubiaozhun: Residents have no Qifubiaozhun in community health service centers (no medical grade), township health centers, community health service stations and village clinics; Other medical institutions outpatient Qifubiaozhun accumulated 200 yuan throughout the year.
Note: The medical expenses for prenatal check-up in outpatient clinics that meet the fertility policy and those for general outpatient clinics are calculated together, and the relevant regulations for general outpatient clinics are implemented.
Two, hypertension, diabetes outpatient medication security
1. Reimbursement ratio: within the scope of the policy, the overall fund payment ratio is 50%.
2. Reimbursement amount: the maximum monthly payment limit for hypertension is 30 yuan; The maximum monthly payment limit for diabetes is 40 yuan; The monthly payment limit for "two diseases" is 50 yuan.
III. Outpatient treatment of severe (chronic) diseases
1, reimbursement ratio: the basic medical insurance fund pays 50%; The proportion of phenylketonuria compensation is 70%.
2. Reimbursement amount: the annual payment limit of the basic medical insurance fund is 4,000 yuan to10.5 million yuan. Insured persons who have undergone radiotherapy and chemotherapy for malignant tumors (including leukemia), chronic renal failure requiring renal dialysis treatment, anti-rejection after kidney transplantation and anti-rejection after liver transplantation can pay a maximum of 300,000 yuan.
Fourth, hospitalization.
Hospital level
Pay line standard
Payment proportion
First hospitalization
Second and above hospitalization
Tertiary medical institutions
Eight hundred yuan
400 yuan
60%
Secondary medical institutions
400 yuan
Two hundred yuan
70%
First-class medical institutions (if the level of community health service center is higher than the first level, the first-class standard shall be implemented)
Two hundred yuan
Two hundred yuan
90%
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The medical expenses incurred by using Class B drugs and Class B diagnosis and treatment projects shall be paid by the individual first10%; The hospitalization expenses incurred by medical treatment in different places are paid by the individual10%; The use of special drugs, in accordance with the provisions of the medical insurance payment standards and proportions of the first self-pay, and then pay according to the provisions of the payment management of class B drugs.