1. The annual social security card payment of 180 yuan for urban residents is urban residents’ medical insurance. It mainly covers urban minors and unemployed residents who have not participated in urban employee medical insurance.
Adopt a government-led financing method, with residents’ individual (family) contributions as the mainstay, supplemented by appropriate government subsidies, and in accordance with the principle of consistent payment standards and treatment levels to provide urban residents with medical needs. Medical insurance system.
2. The following expenses incurred by insured persons at designated medical institutions and designated retail pharmacies shall be included in the reimbursement scope of the Urban Resident Basic Medical Insurance Fund:
(1) Medical expenses for hospitalization (The cost of childbirth for residents can be reimbursed with reference to residents’ hospitalization treatment)
(2) Medical expenses within 7 days before emergency room observation and transfer to hospitalization;
(3) ) Medical expenses that comply with the regulations on special diseases for urban residents;
(4) Other expenses that comply with the regulations.
Extended information:
Reimbursement ratio
First, students and children. In one accounting year, if medical expenses of less than 180,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement ratio is 55%; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement ratio is 60%; There is no minimum payment standard for Grade 1 hospitals, and the reimbursement rate is 65%.
The second is the elderly over 70 years old. In one accounting year, if medical expenses of less than 100,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement ratio is 50%; the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement ratio is 60%; There is no minimum payment standard for Grade 1 hospitals, and the reimbursement rate is 65%.
The third is other urban residents. In one accounting year, if medical expenses of less than 100,000 yuan are incurred that meet the reimbursement scope, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement ratio is 50%; the minimum payment standard for hospitalization in second-level hospitals is 300 yuan, and the reimbursement ratio is 55%. ; There is no minimum payment standard for first-level hospitals, and the reimbursement rate is 60%.
If urban residents are hospitalized for more than two times in one accounting year, starting from the second hospitalization, the minimum standard fee will no longer be charged. If you are transferred to another hospital or hospitalized for two or more times, the difference will be made up according to the prescribed minimum payment standard for transfer or readmission to the hospital.
For example, if a child is sick and is hospitalized in a tertiary hospital and incurs 60,000 yuan of medical expenses that meet the regulations, 32,725 yuan [(60,000 yuan-500 yuan) × 55%] can be reimbursed; For hospitalization in a first-level hospital, the medical expense is 5,000 yuan, and 3,250 yuan can be reimbursed (5,000 yuan × 65%).
Reimbursement Scope
The following expenses incurred by insured persons at designated medical institutions and designated retail pharmacies are included in the reimbursement scope of the Urban Resident Basic Medical Insurance Fund:
( 1) Medical expenses for hospitalization;
(2) Medical expenses within 7 days before emergency stay for observation and transfer to hospitalization;
(3) Special diseases for urban residents outpatient service Prescribed medical expenses;
(4) Other expenses that comply with regulations.
Baidu Encyclopedia-Urban Resident Basic Medical Insurance