Another kind of medical insurance is residents' medical insurance, and the reimbursement ratio is: the reimbursement ratio of first-class hospitals is 65%, and the deductible is 300 yuan; The reimbursement rate of secondary hospitals below 6000 yuan is 65%, and that of hospitals above 6000 yuan is 80%, of which the deductible line of county secondary hospitals is 400 yuan, and the deductible line of municipal secondary hospitals is 600 yuan; Third-level hospitals and county third-level hospitals pay in 600 yuan, and the reimbursement rate is 65%. The reimbursement rate of more than 6000 yuan is 80%, and the deductible line of the municipal tertiary hospital is 800 yuan. 12000 yuan, the reimbursement rate is 55%. 1.2 million yuan or more, the reimbursement rate is 75%.
Reimbursement generally meets the following conditions:
(1) The insured must go to the designated medical institution of basic medical insurance or to the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.
(2) The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the standard scope of medical service facilities and payment standards, and be paid by the basic medical insurance fund according to regulations.
(III) Among the medical expenses that the insured meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the maximum payment limit shall be paid by the social medical co-ordination fund in a unified proportion.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.