Outpatients are required to pay the proportion of disease pooling funds and the proportion of individual pays. For outpatient clinics of designated medical institutions such as community health service stations (outpatient departments and clinics), the proportion of overall fund payment is 85%, and the proportion of individual pays is15%; In the designated medical institutions and community health service centers selected outpatient medical treatment, the overall fund payment ratio is 80%, and the individual pays the proportion of 20%; Selected in the secondary designated medical institutions for outpatient treatment, the overall fund payment ratio is 70%, and the individual pays the proportion of 30%; In the third-level designated medical institutions to choose outpatient treatment, the proportion of overall fund payment is 60%, and the proportion of individual payment is 40%; For those who are selected for outpatient treatment in super-large tertiary designated medical institutions, the proportion of overall fund payment is 55%, and the proportion of individual self-payment is 45%.
Two, Shenyang new rural cooperative medical insurance hospitalization reimbursement ratio:
Shenyang will continue to consolidate and expand the coverage of medical insurance. The participation rate of urban basic medical insurance is stable above 95%, and the participation rate of new rural cooperative medical care for agricultural permanent population is stable above 99%.
This year, Shenyang will further increase the proportion of hospitalization expenses, narrow the distance from the actual hospitalization expenses, and reduce the burden of medical treatment for the masses. The reimbursement ratio of hospitalization expenses in the basic medical insurance for urban workers and the payment ratio of hospitalization expenses in the basic medical insurance policy for urban residents have reached the national and provincial policy standards. The proportion of hospitalization reimbursement for the new rural cooperative medical system increased by 5 percentage points on the existing basis, reaching 75%.
Three, Shenyang residents medical insurance hospitalization reimbursement ratio:
The annual payment limit of medical insurance for students and minor residents is slightly higher, reaching a maximum of 225,000 yuan, of which the annual maximum payment limit of basic medical insurance pooling fund is1250,000 yuan, and the annual maximum payment limit of large-scale subsidized medical insurance is1000,000 yuan.
The so-called Qifubiaozhun refers to the amount of hospitalization medical expenses that individuals must pay before the start of the overall fund. Mental illness, acute and chronic infectious hepatitis, infiltrative pulmonary tuberculosis and chronic fibrocavernous pulmonary tuberculosis do not have the minimum threshold for pooling funds. Patients with malignant tumors who are hospitalized many times in a natural year only need to pay the minimum payment standard of the overall fund for the first hospitalization every year.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.