The out-of-pocket proportion of hospitalization medical expenses for urban and rural residents generally increased 10%, with an average of 75%; The compensation policy for subsection calculation of serious illness insurance is uniformly adjusted to a standard and reimbursed at 75%.
1. Level-3 first-class hospital (level-1 charging standard): the deductible line of hospitals outside the province is 1500 yuan, and the payment ratio is 55%;
2. The deductible line of provincial and municipal hospitals in the province is 1000 yuan, and the payment ratio is 60%;
3. Third-class B and second-class A hospitals (second-class charging standard): 500 yuan, the deductible line of provincial and municipal hospitals, with a payment ratio of 70%;
4. The deductible line of county-level hospitals is 400 yuan, and the payment ratio is 75%.
5. Level II hospital (level III charging standard): deductible line 100 yuan, and the payment ratio is 85%.
Proportion of reimbursement for serious illness medical insurance in Shanxi
The funding standard for serious illness insurance for urban and rural residents will be raised to 50 yuan per person per year. Cancel the subsection compensation method of serious illness insurance, and the part of the insured person's hospitalization expenses in the medical insurance catalogue that exceeds 654.38+0,000 yuan will be paid by the serious illness insurance fund at a unified rate of 75%. The maximum payment of the insured patient's serious illness insurance fund within one year is 400,000 yuan.
Legal basis:
Article 25 of People's Republic of China (PRC) Social Insurance Law:
The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.
Article 28 of the Social Insurance Law of People's Republic of China (PRC):
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29 of People's Republic of China (PRC) Social Insurance Law:
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. 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.