Legal analysis: the hospitalization expenses of insured residents within the policy scope of designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund. Insured residents are hospitalized in provincial-level designated medical institutions, and the Qifubiaozhun is determined according to about 10% of the average hospitalization expenses of each provincial-level designated medical institution in the previous year, not less than 1500 yuan. Within the scope of the policy, the proportion of hospitalization medical expenses paid shall not be less than 50%. The specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of the medical insurance fund for urban and rural residents and the medical conditions of the insured residents in the overall planning areas. The medical insurance fund for urban and rural residents sets the maximum payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million yuan.

Legal basis: Measures for the Implementation of Basic Medical Insurance for Urban and Rural Residents in Hunan Province

Article 27 The insured residents' hospitalization medical expenses within the policy scope of the designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.

Article 28 When insured residents are hospitalized in provincial-level designated medical institutions, the Qifubiaozhun shall be determined according to about 10% of the average hospitalization expenses of each provincial-level designated medical institution in the previous year, and not less than 1500 yuan. Within the scope of the policy, the proportion of hospitalization medical expenses paid shall not be less than 50%. The specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of the medical insurance fund for urban and rural residents in the overall planning areas and the medical conditions of the insured residents.

Thirtieth medical insurance funds for urban and rural residents set the maximum payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million yuan.