Poor households have different basic medical insurance according to different groups of people, including residents' medical insurance and urban residents' medical insurance, and the proportion of hospitalization reimbursement is also different.

Proportion of reimbursement for poor households

1, hospitalization reimbursement ratio of poor households with residents' medical insurance:

(1) The reasonable and necessary reimbursement rate of medical expenses incurred by hospitalization in town health centers is 60%; (2) The reimbursement rate of reasonable and necessary medical expenses arising from hospitalization in secondary hospitals is 40%; (3) The proportion of reasonable and necessary medical expenses in tertiary hospitals is 30%; 2. Proportion of hospitalization reimbursement for urban residents with poor medical insurance: within one settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occurred:

(1) There is no minimum threshold for first-class hospitals, and the proportion of reasonable and necessary medical expenses incurred in hospitalization is 60%;

(2) The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the proportion of reasonable and necessary medical expenses incurred in hospitalization is 55%;

(3) The minimum threshold for tertiary hospitals is 659 yuan, and the proportion of reasonable and necessary medical expenses incurred in hospitalization is 50%, with an upper limit of 2,000 yuan. In short, poor households have different basic medical insurance according to different groups of people, including residents' medical insurance and urban residents' medical insurance, and the proportion of hospitalization reimbursement is also different.

legal ground

Regulations on the supervision and administration of the use of medical insurance funds

Article 8 The use of medical insurance funds shall conform to the scope of payment stipulated by the state. The scope of medical insurance fund payment shall be formulated by the administrative department of medical insurance in the State Council according to law. The people's governments of provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the authority and procedures prescribed by the state, supplement the specific items and standards paid by the medical security fund within their respective administrative areas, and report them to the administrative department of medical security of the State Council for the record.

Article 9 The State shall establish and improve a unified national medical security handling management system, provide standardized and standardized medical security handling services, and realize full coverage of provinces, cities, counties, towns (streets) and villages (communities).

People's Republic of China (PRC) social insurance law

Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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.