Reimbursement ratio:
1, retired cadres, retired workers, disabled persons on duty, patients with tertiary silicosis, and secondary disabled soldiers who were hospitalized due to illness before the founding of the People's Republic of China, their medical and drug expenses were reimbursed 100%.
2, retired workers working for more than 30 years, the medical expenses reimbursement of 90%.
3. Retired employees with working experience of 2 1 to less than 30 years will be reimbursed 85% of medical expenses.
4. For retired employees with the length of service 15 to 2 1 year and below, 80% of medical expenses will be reimbursed.
5. Retired employees with less than 15 years of service will be reimbursed 75% of medical expenses.
6, retired workers, medical expenses reimbursement 75%.
7.60% of the hospital bed fee will be reimbursed, and the hospital bed fee will be charged by the company regardless of any hospitalization method.
Reimbursement deductible:
Total medical expenses for one-time hospitalization-Qifubiaozhun-expenses outside the scope of basic medical care-20% of expenses borne by individuals first)&; Times; [(75+ age&; Times; 0.2)/ 100], qifubiaozhun is divided by hospital level: qifubiaozhun of inpatient pooling fund in first-class hospitals is 360 yuan; 580 yuan, a secondary hospital; 970 yuan, a tertiary hospital; There is no grade of community health service center hospitalization pooling fund Qifubiaozhun for 360 yuan. Qifubiaozhun of hospitalization pooling fund is calculated on a per-time basis. In a natural year, if you stay in a hospital above the second level for many times (including outpatient special diseases and family sickbeds), you will be exempted from 100 yuan, with a minimum of not less than 360 yuan. If the insured needs to be transferred from a low-level designated hospital to a high-level designated hospital due to illness, only the difference between the overall fund Qifubiaozhun will be paid.
Does not belong to the scope of residents' medical insurance reimbursement:
1. General outpatient medical expenses;
2. Hospitalization expenses of non-designated medical institutions;
3 does not belong to the urban residents' basic medical insurance drug list, diagnosis and treatment project list and medical service facilities list within the scope of payment;
4. Medical expenses incurred by driving a vehicle, driving a vehicle with an invalid license, fighting after drinking, taking or injecting drugs, and committing crimes during the period of driving without a license or temporary suspension of driving license;
5. Medical expenses for suicide and self-mutilation;
6. Medical expenses incurred abroad and abroad;
7 medical expenses for injuries and sequelae caused by medical accidents and other liability accidents;
8. Other circumstances in which the State and this Municipality stipulate that payment will not be made.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.