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Reimbursement ratio and scope of medical insurance for urban residents in 2017 1. Outpatient reimbursement There is no deductible for general outpatient services. All insured residents enjoy general outpatient treatment.
Within a medical insurance year, there is no deductible for general outpatient services. Medical expenses within the payment range of the outpatient overall fund are reimbursed at a rate of 60%. The maximum annual individual payment limit of the overall fund is 400 yuan.
2. Hospitalization reimbursement ratio: The longer the insured period is, the greater the reimbursement ratio will be. For every 5 years of continuous payment by insured residents, the hospitalization reimbursement ratio of the medical insurance fund will increase by 5 percentage points, and the total will not exceed 10 percentage points.
If you participate in the insurance for 10 consecutive years from 2007, the hospitalization reimbursement ratio in third-level, second-level, and first-level hospitals will reach 70%, 80%, and 90% respectively.
3. Secondary reimbursement ratio. After "secondary reimbursement", there may be "reimbursement". Among the medical expenses incurred by insured residents for a single hospitalization, the part that falls within the payment scope of the urban residents' basic medical insurance co-ordinating fund will be included in the basic medical insurance co-ordinating fund.
After proportional payment, if the personal burden exceeds 8,000 yuan, the excess portion will be "secondary reimbursed" at a rate of 55% from the critical illness insurance funds.
Medical expenses incurred by insured residents for multiple hospitalizations in an individual year. After payment of basic medical insurance and "secondary reimbursement", the accumulated annual hospitalization medical expenses (including compliant and reasonable self-pay portion) exceeds 25,000 yuan.
, the excess amount will be "reimbursed" at a rate of 55% by the critical illness insurance funds, and the annual maximum personal payment limit of the critical illness insurance funds is 250,000 yuan.
4. The reimbursement amount can be reimbursed up to 370,000 yuan per year. Residents participating in our city's urban resident medical insurance have an annual payment limit of 120,000 yuan for basic medical insurance and 250,000 yuan for critical illness insurance.
Therefore, insured persons can be reimbursed up to 370,000 yuan per year.
The 2017 Urban Resident Medical Insurance payment process is from August 1, 2016 to November 30, 2016. The overdue payment system will be closed and payments will no longer be accepted.
1. General residents in urban areas, primary school, middle and high school students, and children participating in insurance for the first time: Please bring the original and copy of your household registration book (or resident ID card) to the community where your household registration is located (or family residence) to apply for insurance.
After 2 or 5 working days, please bring your household registration book or resident ID card to the nearest bank branch to pay; starting from the next day of payment, please bring your payment voucher and medical insurance card cost of 7 yuan to the place of household registration (or home).
Apply for a medical insurance card at the district social insurance center in your place of residence.
3. Renewal of insured persons: Please bring your resident ID card or resident medical insurance card and go directly to the nearest bank branch to pay.