2, Qifubiaozhun (also known as the threshold fee) is the same as the basic medical insurance for urban workers, that is, three-level 980 yuan, two-level 720 yuan and one-level 540 yuan.
3. Medical treatment management: The residents insured by the basic medical insurance for urban residents shall implement the system of fixed-point first visit and two-way referral. The designated medical institutions for the first visit are community health service centers, specialized hospitals, hospital-store cooperation and secondary and below medical institutions, and some tertiary comprehensive medical institutions are transferred to specialized medical institutions. When insured residents seek medical treatment, they should first seek medical treatment in the first-visit medical institution. If referral treatment is really necessary due to illness, the first-visit medical institution shall issue a referral certificate before being transferred to the designated referral hospital for hospitalization.
Class A drugs 100%, class B drugs 95%, class C drugs 0%, 80% reimbursement ceiling is 85,000. Policies vary from place to place, and there are differences between counties. If you want to have a detailed and accurate answer, you can only ask the social security office. Class C drugs: disposable supplies (such as infusion tubes and syringes), imported drugs and blood borrowing fees (it is recommended that you donate blood free of charge every year, and blood use is free). 202 1 Latest payment standard of medical insurance for urban and rural residents: According to the notice issued by the National Medical Insurance Bureau, the individual payment and financial subsidy standard of basic medical insurance for urban and rural residents in 202 1 rose again. Among them, the individual payment standard was raised from 250 yuan to 280 yuan, and the supplementary standard of financial subsidies was also raised from 30 yuan and from 520 yuan to 550 yuan.
Advantages of basic medical insurance for urban residents
First, when the insured is sick, especially when he is seriously ill, the economic burden is reduced to some extent.
Second, when the insured is in good health, the insurance premium paid can be used to help other insured persons, thus embodying the spirit of "one person is sick and all families help each other".
The third is to relieve the worries of the insured. In order to encourage urban residents to participate in insurance, urban residents who meet the insurance conditions are divided according to their insurance time, and different medical deductible periods are set. Within six months after the implementation of the "Measures", the medical deductible period is three months, and there is no deductible period for minor residents; After six months of insurance (including minor residents, the same below), the starting period of medical treatment is one year; After one year, the deductible of medical treatment period is extended to two years; There is no deductible period for low-income residents to seek medical treatment.
Proportion of reimbursement for basic medical insurance for urban residents
First, students and children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio 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 of 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%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate 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 of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.