Fuzhou citizens who have purchased medical insurance can enjoy the benefits of partial reimbursement of medical expenses when they save their lives. Then, what is the reimbursement ratio of Fuzhou medical insurance? This is divided into two categories, one is the proportion of reimbursement for urban residents and college students, and the other is the proportion of reimbursement for employees.
Proportion of reimbursement for urban residents and college students
First, the general outpatient compensation treatment
Reimbursement ratio: 50%
Annual maximum payment limit (400 yuan/person calculated according to actual reimbursement amount)
Note: The maximum annual payment limit for college students (including minimum payment standard and proportional out-of-pocket expenses): 2,000 yuan/person.
Second, the special disease outpatient compensation treatment
The reimbursement rate for outpatient service for special diseases is 60%.
Outpatient expenses for serious diseases and special diseases (within 60,000 yuan (including 60,000 yuan): 70%; More than 60,000 yuan to 6.5438+0.4 million yuan (including 40% of the reimbursement ratio of 6.5438+0.4 million yuan)
Third, hospitalization compensation treatment
The expenses in basic medical insurance coverage are ≤ 60,000 yuan (the reimbursement ratio is 55%-90%).
60 thousand yuan
According to the above qifubiaozhun, the number of hospitalizations will decrease 100 yuan in turn until it drops to zero.
Employee reimbursement ratio
First, the general outpatient compensation treatment
Pay line 1500 yuan and below: pay by personal account, and pay in cash when personal account is insufficient.
1above 500 yuan-below 6000 yuan (inclusive)
Active employees: 60%-65%, retired employees: 70%-75%.
Two, employee medical insurance outpatient special diseases
1, deductible line and capping line
The deductible line of outpatient special diseases and treatment items: 800 yuan, and the highest payment limit of the overall fund in that year: 6,543,800 yuan+0.2 million yuan.
On-the-job personnel special diseases and treatment project expenses: 85%-90%.
Retirees' expenses for special diseases and treatment items: 90%-94%.
Three, the hospitalization fund
Qifubiaozhun for the first hospitalization: the first hospitalization deductible line of tertiary designated medical institutions is 800 yuan, and the first hospitalization deductible line of secondary and below designated medical institutions is 600 yuan (including community health service centers and township hospitals 300 yuan).
Hospitalization for many times during the year: 200 yuan decreased gradually every time until it decreased to zero.
2, overall fund payment ratio
On-the-job employee hospitalization medical expenses: 80%-92%
Hospitalization medical expenses of retirees: 90%-95%.
Four. Supplementary insurance for large medical expenses of employees
65438+200,000 yuan
It is suggested that the reimbursement rate of medical insurance in Fuzhou has different standards according to different groups of people, and the reimbursement rate of the same group in different outpatient departments is also different. 50% reimbursement for urban residents' general outpatient service and 60% reimbursement for special disease outpatient service; 60%-65% of urban workers' general outpatient service and 85%-90% of special disease outpatient service.
The above is the knowledge of finishing.