The basic medical insurance shall implement the drug list, diagnosis and treatment items, high-value medical consumables list and the scope of medical service facilities uniformly formulated by the Provincial Department of Human Resources and Social Security. Beyond the scope of the catalogue, the basic medical insurance fund will not pay.

Binzhou medical insurance reimbursement ratio

resident

The medical insurance benefits of insured residents include hospitalization, general outpatient treatment, outpatient chronic disease treatment and serious illness insurance benefits, and the reimbursement conditions are all expenses within the scope of the policy.

The first is hospitalization. Township hospitals implement the policy of full reimbursement for hospitalization above 200 yuan; The reimbursement rates of secondary and tertiary hospitals are 75% and 50% respectively.

The second is general outpatient treatment. On 20 17, a personal account was implemented, with each person in 60 yuan every year, which can be carried forward for use.

The third is the treatment of chronic diseases (that is, special diseases) in outpatient clinics. Anyone who meets the disease and identification standards can enjoy it. If the annual deductible line is above 200 yuan, the expenses will be reimbursed by 50%, and the annual expenses will not exceed 5,000 yuan.

The fourth is the treatment of critical illness insurance. On the basis of reimbursement of basic medical insurance, 50% of the medical expenses within the policy scope borne by individuals, 1.2 million yuan and above, 1 10,000 yuan and below; 65,438+10,000 yuan and more but less than 200,000 yuan will be compensated by 60%; 200,000 yuan and above will be compensated by 65%. Within a medical year, each person will be given a maximum compensation of 300,000 yuan. In 20 17 years, 18 kinds of targeted anti-tumor drugs and specific drugs for treating other diseases will be included in the scope of reimbursement for serious illness, and personal compensation will be implemented, with a minimum threshold of 20,000 yuan, and reimbursement will be made according to 40% above the minimum threshold, with an annual payment limit of 200,000 yuan per person.

Proportion of medical insurance reimbursement for on-the-job employees:

1. After the emergency treatment in the hospital, the medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;

2. If it is a retiree under 70 years old,1.The expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%;

3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed.

Note: No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20,000 yuan.

In case of hospitalization expenses, employees and retirees should pay the minimum amount 1300 yuan when using the basic medical insurance for the first time in a year.

And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

The hospitalization reimbursement standard is related to the hospital level where the insured lives:

Note: If you live in a tertiary hospital.

1, from qifubiaozhun to 30,000 yuan, the employee pays 15%, which means 85% reimbursement;

2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;

3. 95% of the part exceeding the maximum payment limit of 40,000 yuan can be reimbursed, as long as the employee pays 5%;

4. Retirees pay 60% of the employees.