1, outpatient reimbursement ratio, there is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. In a medical insurance year, there is no deductible for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed at the rate of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan;

2. The proportion of hospitalization reimbursement. The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively;

3. There may be "second reimbursement" after the "second reimbursement". The medical expenses incurred by the insured residents in a single hospitalization belong to the part paid by the basic medical insurance fund for urban residents. After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to the excess part according to the proportion of 55%.

Reimbursement standard of medical insurance for chronic diseases:

1. 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 expenses of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure were further increased by 10 percentage point.

2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and the maximum payment limit for chronic diseases shall not be exceeded within one medical year (or validity period);

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

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, the reimbursement rate of medical insurance in Hunan is 95% for hospitalization, 90% for secondary hospitals, 85% for tertiary hospitals, 85% for general outpatient primary hospitals, 80% for secondary hospitals and 75% for tertiary hospitals, with an annual limit of 4,500-5,500 yuan. The proportion of medical insurance reimbursement is different in different regions. Urban and rural residents who have lived in different places for a long time, urban and rural residents who have reached the age of 60 and women who have reached the age of 55, urban and rural residents who work in different places, and students and children who live with them shall be registered for medical treatment in different places. The deductible standard for hospitalization in the registered place is 400 yuan, a first-class hospital and 800 yuan, 2000 yuan, and the reimbursement ratio is implemented in the designated hospital of Baoji City.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.