1. Proportion of reimbursement for hospitalization

The reimbursement ratio of medical insurance ranges from 85% to 95%, and the standard of reimbursement for hospitalization is related to the level of the hospital where the insured person lives:

1. If the insured person lives in a tertiary hospital, the employee will pay 15% from the minimum threshold to 3, yuan, that is, 85% will be reimbursed.

employees will pay 1% and reimburse 9% of the expenses ranging from RMB2, to RMB4,.

3. 95% of the expenses exceeding 4, yuan to the maximum payment limit can be reimbursed, and employees only need to pay 5%.

4. The proportion of retirees' personal payment is 6% of the on-the-job (that is, the above-mentioned) employees, but all those below the minimum threshold are paid by individuals.

2. deductible line for hospitalization reimbursement

1. 2 yuan, a first-class hospital

2. 5 yuan, a second-class hospital

3. 8 yuan, a third-class hospital

4.

III. Proportion of reimbursement for outpatient chronic diseases

Outpatient chronic diseases are divided into Class A chronic diseases and Class B chronic diseases.

1. The outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The outpatient hemodialysis expenses, peritoneal dialysis expenses and the expenses of taking cyclosporine A after organ transplantation of patients with chronic renal failure were increased by 1 percentage points.

2. The threshold for chronic diseases of Class B: 3 yuan. The outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid by 8% above the deductible standard, and the maximum payment limit for chronic diseases shall not be exceeded within one medical year.

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the first identified two diseases, and calculate the deductible line for each disease separately. The identification and management of chronic diseases and the maximum payment limit will be adjusted by the human resources and social security department according to the income and expenditure of the overall fund. Criteria, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

25 years is a cumulative payment of 25 years, not 25 years in a row. According to the provisions of medical insurance payment, men are required to pay for 25 years and women for 2 years, and they can enjoy the treatment of basic medical insurance after retirement. As for the payment time, under normal circumstances, you can enjoy medical insurance benefits for life after retirement if you have paid for 25 years or 2 years. The interruption of medical insurance payment will not affect the previous payment period, but you will not enjoy medical insurance reimbursement during the interruption of payment.

Taking Hunan as an example, the hospitalization expenses of insured residents within the policy scope of designated medical institutions of basic medical insurance in the overall planning area, and the part above the minimum threshold shall be paid by the urban and rural residents' medical insurance fund in proportion: township hospitals and community health service institutions shall not be less than 8%; County-level medical institutions are not less than 7%; Municipal medical institutions are not less than 6%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.

reimbursement process of hospitalization medical insurance card:

if a patient with a medical insurance card wants to go to the hospital after illness, the process of going to the designated medical insurance unit with a medical insurance card is as follows: when the insured person is sick, he can go directly to the local designated medical institution with a medical insurance manual and IC card. The general procedure is as follows: holding the medical insurance manual and IC card-registering with the hospital medical insurance office-examining and verifying the card-paying the hospitalization deposit-staying in the hospital-the patient's consent and signature are required for the self-funded items-cash or IC card is used to settle the Qifubiaozhun and the self-paid part of the self-paid proportion-the hospital will advance the expenses within the overall planning scope-and settle the discharge.

what are the reimbursement conditions

1. The insured must go to the designated medical institutions of basic medical insurance for medical treatment and medicine purchase.

2. The medical expenses incurred by the insured in the process of seeing a doctor must conform to the basic medical insurance drug list, diagnosis and treatment items, the scope of medical service facilities standards and payment standards before they can be reimbursed.

3. among the medical expenses of the insured who meet the scope of medical insurance payment, the part above the minimum payment standard and below the maximum payment limit of the social medical pooling fund shall be paid by the social medical pooling fund in a unified proportion.

In many areas, medical insurance stipulates that men must pay for 25 years and women must pay for 2 years before they can continue to enjoy basic medical insurance benefits after retirement. The "25 years" mentioned here is just a cumulative payment of 25 years, not a continuous payment of 25 years.

After all, people often make job changes, and they may not always stay in one city, but may go to other cities for development. And if the medical insurance stipulates that it will be paid continuously for 25 years, it will be difficult to achieve it.

because the payment period stipulated in medical insurance is cumulative, it is not limited to one insured place. If the insured has paid medical insurance in more than one place, the medical insurance paid in these places can be calculated cumulatively, but the continuous payment period will have to be recalculated.

for example, if someone has paid medical insurance in place A for 1 years, and then went to place B, and paid medical insurance in place B for 5 years, then his cumulative payment period of medical insurance is 15 years.

and we need to pay attention to the fact that the payment period stipulated by medical insurance may be different in different places. Not all regions require men to pay for 25 years and women to pay for 2 years.

What materials are needed for reimbursement of hospitalization expenses

1. Original and photocopy of the insured person's ID card (if entrusted by others, the original and photocopy of the entrusted person's ID card must be provided at the same time);

2. The original and photocopy of the insured's medical insurance card. If there is no medical insurance card, the insured shall provide the original and photocopy of his bank passbook (card);

3. Original and photocopy of the charge receipt;

4. Detailed list of hospitalization expenses (note: it is not a daily expense list);

5. Discharge summary or discharge record. If the discharge summary is handwritten in the medical record, copy the discharge summary and the cover of the medical record;

6. certificate of disease diagnosis (death certificate is required in case of death);

7. Minors should provide household registration book (photocopy) and guardian ID card at the same time. If they give birth or terminate pregnancy, they should also provide relevant certificates from the family planning department (original and photocopy of marriage certificate and birth permit), rural five-guarantee households should provide valid certificates issued by the civil affairs department, original and photocopy of driver's license and driving license should be provided for traffic accidents, accident confirmation letter from the Public Security Traffic Management Bureau and mediation letter of compensation for traffic accidents, and the injury process should be additionally stated for fractures.

8. If medical treatment has been filed outside the city, you need to bring an application form for transfer (diagnosis) or an application form for medical insurance non-designated medical institutions. If you live in the field for a long time, you must provide a residence certificate issued by the neighborhood Committee or village Committee of your place of residence.

Legal basis:

Opinions of the State Council on Integrating the Basic Medical Insurance System for Urban and Rural Residents

II. Integrating the Basic System Policies

(III) Unifying the guaranteed benefits.

follow the principle of moderate security and balance of payments, balance the treatment of urban and rural security, gradually unify the scope of security and payment standards, and provide fair basic medical security for the insured. Properly handle the special safeguard policy before integration, and do a good job of transition and convergence.

the urban and rural residents' medical insurance fund is mainly used to pay the medical expenses incurred by the insured persons for hospitalization and outpatient service. Stabilize the level of hospitalization security, and maintain the proportion of hospitalization expenses within the policy range at around 75%. Further improve outpatient co-ordination and gradually improve the level of outpatient support. Gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.

Law of the People's Republic of China on Basic Medical Care and Health Promotion

Article 82 The expenses of basic medical services are mainly paid by basic medical insurance funds and individuals. The state raises basic medical insurance funds through various channels according to law, and gradually improves the mechanism for sustainable financing and adjustment of the level of protection of basic medical insurance.

citizens have the right and obligation to participate in basic medical insurance according to law. Employers and employees pay basic medical insurance premiums for employees in accordance with state regulations. Urban and rural residents pay basic medical insurance premiums for urban and rural residents in accordance with regulations.