First, explain the proportion of social security medical reimbursement. The use of special medical materials or disposable medical materials with a unit price of more than/kloc-0,000 yuan, as well as the installation and replacement of artificial organs, shall be paid by the basic medical pooling fund at 90% of the domestic general price. 90% of the basic medical expenses for outpatient dialysis of chronic renal failure, outpatient anti-rejection drugs after organ transplantation, outpatient chemotherapy, radiotherapy, interventional therapy or radionuclide therapy shall be paid by the basic pooling fund. Outpatient special examination and treatment costs by the basic medical insurance fund to pay 80%, the individual pays 20%. Continuous payment is linked to the reimbursement ratio. After two years of continuous insurance, the insurance proportion increased to 765,438+0%, after four years of continuous insurance, the insurance proportion increased to 72%, and so on.

Understand the proportion of social security medical reimbursement, and the deductible line and reimbursement ratio of urban residents' basic medical insurance are determined according to the types of insured persons.

First, students and children. In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The third-level medical threshold is 500 yuan, and the reimbursement rate is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

The second is the elderly over 70 years old. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; First-class hospitals do not set qifubiaozhun, and the insurance ratio is 65%;

Third, other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, with the insurance ratio of 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the insurance ratio is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%. Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Hospitalization or hospitalization for more than two times, make up the difference of hospitalization Qifubiaozhun in accordance with the provisions of transfer or re-hospitalization.