The reimbursement rate of Xiamen social security card for medical treatment in different places is 88% of the threshold fee above 3,000 yuan, 90% of 3,000-5,000 yuan, 92% of 5,000-1 10,000 yuan, and 95% of110,000 yuan, including 80% of Class B drugs, 70% of precious drugs and 70% of special drugs. The reimbursement rate of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 65%; The reimbursement rate of first-class hospitals is 75%.

Key points of medical insurance in Xiamen:

1. Medical treatment in different places. If medical treatment in different places is not filed, it cannot be directly settled in different places, but it can still be reimbursed when you return to Xiamen, but you must pay 10% first, and then reimburse according to medical insurance benefits. For example, if you spend 20,000 yuan on medical treatment in a different place and you don't file it, then you can only count it as 18000 when you come back, and deduct 2000 yuan first and don't report it. Individuals can apply for filing in the iXiamen APP or the official account of Xiamen Medical Insurance WeChat.

2. Xiamen Medical Insurance has a health account. In the second half of the year, each employee's 300 yuan can be directly used to buy medicine, which is equivalent to giving everyone a 300 yuan except the medical insurance card. This treatment is the envy of many other provinces and cities, and other provinces and cities have no health accounts at all.

3. Xiamen Medical Insurance has no outpatient chronic disease system and is not limited to outpatient diseases. General outpatient service and special outpatient service are combined to enjoy the above-mentioned outpatient treatment. The amount of outpatient and hospitalization in the whole year was 654.38+million, the total amount was not high, but the reimbursement ratio was relatively high. For patients with malignant tumor, organ transplantation and uremia, there is no need to apply for special outpatient treatment separately, which is convenient for patients to seek medical treatment.

The special outpatient treatment enjoyed by other provinces and cities only within the scope of specific diseases has been turned into a threshold by Xiamen.

legal ground

Guiding opinions on further improving the settlement of medical expenses for medical treatment in different places in basic medical insurance

The inpatient medical expenses incurred by retirees in different provinces shall, in principle, be paid within the scope specified in the place of residence (including drug list, diagnosis and treatment items and medical service facilities standards); The Qifubiaozhun, payment proportion and payment limit of the medical insurance pooling fund shall, in principle, implement the local medical treatment standard stipulated by the insured place, and shall not be implemented according to the proportion of payment for medical treatment transferred abroad. Upon my application, I can transfer the funds in my personal account to individuals for outpatient medical treatment and medicine purchase.

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

Twenty-eighth, in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations, paid from the basic medical insurance fund.

Twenty-ninth insured medical expenses should be paid by the basic medical insurance fund, by the social insurance agencies, medical institutions and pharmaceutical business units directly settled. 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.