1, students, 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%.

2. Older people 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 for 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%.

3. Other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for 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%.

Two, Ningxia medical insurance reimbursement conditions

1, normal insurance payment (indicating the insurance payment status at the time of hospitalization) and the treatment review expires (unit insurance payment is 30 days, and individual insurance payment is 6 months).

2, the disease conforms to the "basic medical insurance inpatient disease directory"

3. Complete information

Reimbursement ratio:

The medical expenses incurred by the insured who signed the framework agreement for medical treatment in different places in our district belong to the part paid by the basic medical insurance fund (including the expenses paid by individual accounts), and the third-class and first-class medical institutions are settled monthly or quarterly by the social security bureau of the autonomous region; Other medical institutions shall be settled monthly or quarterly by the social insurance agencies in the overall planning area.

For people who live across provinces, gradually transfer personal account funds to my social security card financial account.

-Proportion and process of medical insurance reimbursement in Ningxia Province

At present, the medical insurance payment of urban and rural residents in our city has different reimbursement ratios according to the first, second and third grades. The maximum payment limits are 70,000 yuan for Grade I, 0.2 million yuan for Grade II/KLOC-0, and 0.6 million yuan for Grade III/KLOC-0. In addition, in different levels of hospitals, Qifubiaozhun is also different. Among them, the qifubiaozhun of first-class, second-class, third-class B (including Ningnan Hospital, Autonomous Region Chinese Medicine Hospital and Yinchuan Chinese Medicine Hospital) and third-class A designated medical institutions are: 200 yuan, 400 yuan, 700 yuan and 1000 yuan respectively.

According to the reimbursement ratio of different hospitals, it is more cost-effective for insured residents to choose a first-class designated hospital for medical treatment, with low threshold and high reimbursement ratio.

In addition, all residents who participate in medical insurance for urban and rural residents can enjoy serious illness insurance for urban and rural residents. After the basic medical reimbursement, if the individual's self-financed and compliant medical expenses still exceed 8,400 yuan, he can enjoy the treatment of serious illness insurance for urban and rural residents, and the insurance company will pay in proportion, with a minimum reimbursement of 50% and no upper limit.

legal ground

Article 29 of the 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.