Reimbursement standard
1. Hospitalization: The reimbursement rate of hospitalization medical expenses between the Qifubiaozhun and the highest payment limit in line with the policy is 85% in the first-class hospitals (community health service centers and town health centers) that implement the basic drug system, and the reimbursement rate is increased by 2 percentage points if the village clinics of outpatient contracted medical institutions are transferred to the town health centers of medical institutions for hospitalization. The reimbursement rate of other first-level hospitals (County Second Hospital and County Maternal and Child Health Hospital) is 75%, the reimbursement rate of second-level hospitals (County People's Hospital and County Chinese Medicine Hospital) is 70%, and the reimbursement rate of third-level hospitals (Binhai Affiliated Hospital, Binzhou People's Hospital, Central Hospital and Third Hospital) is 75%. ) It is 55%.
2. General outpatient medical treatment: within one year, the minimum payment standard of outpatient medical expenses is 50 yuan, and the maximum payment limit of the insured person's outpatient pooling fund this year is 900 yuan. The reimbursement rate of general outpatient co-ordination medical expenses between Qifubiaozhun and the maximum payment limit is directly 50%; The trouble of canceling the secondary compensation system.
3. Outpatient chronic disease treatment: Outpatient chronic diseases include malignant tumor (including leukemia), uremia, organ transplantation, diabetes (complicated with infection or complications of heart, kidney, eyes and nerves), tertiary hypertension (complications of heart, brain and kidney), rheumatoid disease (active stage), cor pulmonale (right heart failure) and cerebral hemorrhage (including cerebral infarction). The basic medical insurance for urban and rural residents gives appropriate subsidies to the outpatient medical expenses of the above-mentioned chronic diseases. Within a year, the qifubiaozhun for outpatient chronic diseases is 500 yuan, which is calculated separately from the qifubiaozhun for hospitalization, and the highest subsidy ratio for outpatient chronic medical expenses within the policy scope between qifubiaozhun and the highest payment limit is no more than 50%.
4. Treatment of urban and rural residents' serious illness insurance: within one year, the inpatient medical expenses incurred by insured residents and the outpatient chronic disease expenses included in the overall fund payment scope will be compensated by residents' serious illness insurance after the compensation of urban and rural residents' basic medical insurance. The deductible line of serious illness insurance for urban and rural residents is 6.5438+0.2 million yuan, and the compliance medical expenses borne by individuals below 6.5438+0.2 million yuan will not be compensated. 50% compensation will be given if the compliance medical expenses borne by individuals are more than RMB10.2 million (including RMB10.2 million) but less than RMB10.0 million; More than 6,543,800 yuan (including 6,543,800 yuan) and less than 200,000 yuan shall be compensated by 60%; More than 200,000 yuan (including 200,000 yuan) will be compensated by 65%, with a maximum compensation of 300,000 yuan per person.
Legal basis: legal basis: 202 1 1 the proportion and scope of medical insurance reimbursement for urban residents. Students and children (1less than 0.8 million yuan); Two, the elderly over 70 years old (654.38+ ten thousand yuan); Three, other urban residents (654.38+ten thousand yuan).