Proportion of hospitalization reimbursement for basic medical insurance

(Source: Luoyang Medical Insurance, the same below)

The proportion of reimbursement for material expenses shall be reimbursed according to the proportion stipulated in the Catalogue of Medical Consumables in Henan Province. Class A pays 20% and Class B pays 30%.

Proportion of reimbursement for large medical expenses of employees

Maximum limit, reimbursement ratio and deductible line

At present, the maximum payment limit of the basic medical insurance fund for urban workers in our city is 654.38 million yuan. The large payment standard of medical insurance for employees is 190/ year 240 yuan, and the maximum reimbursement amount for serious illness is 4.2 million/470,000 yuan.

(1) hospitalization

Hospital grade

incumbent

retire

Tertiary hospital

85%

87%

Secondary hospital

90%

92%

First-class hospital

(including community)

95%

97%

(2) Outpatient medical treatment for special diseases

On-the-job employees pay 80%, and retired (retired) personnel pay 85%.

(3) Medical treatment of major diseases

The proportion of hospitalization medical expenses paid is 85% for county-level medical institutions, 75% for municipal medical institutions and 70% for provincial medical institutions; The proportion of outpatient medical expenses is 85%, the proportion of outpatient peritoneal dialysis for end-stage renal disease is 90%, and the proportion of retired (resigned) personnel is increased by 2%.

(four) the policy of payment ratio for referral and transfer of insured persons and medical treatment in different places is consistent with employee medical insurance.

Source: Photo Network ID40 1778039

Luoyang urban and rural residents

Qifubiaozhun and reimbursement ratio of insured residents in 2022

14 years of age (including 14 years of age) insured residents Qifubiaozhun halved, and other insured residents hospitalized in hospitals at or above the county level for the second time and later halved; If you are hospitalized for the same disease for the second time within 30 days, you will only pay the Qifubiaozhun once. The second hospitalization, the hospital level is higher than the first hospital level, only pay the difference between Qifubiaozhun; If the insured residents in our city are hospitalized in Chinese medicine hospitals at or above the county level, the Qifubiaozhun for hospitalization reimbursement will be reduced by 100 yuan on the basis of the standards stipulated by medical institutions at the same level. The reimbursement rate of hospitalization medical expenses for insured residents using Chinese medicine services increased by 5%. Chinese medicine service projects refer to Chinese herbal pieces, Chinese patent medicines, Chinese medicine preparations and Chinese medicine diagnosis and treatment projects included in the scope of reimbursement of basic medical insurance.

Class A drugs shall be reimbursed according to the proportion in the above table, and class B drugs shall be reduced by 10% on the basis of class A drug reimbursement.

Proportion, deductible line and maximum amount of reimbursement for serious illness of urban and rural residents

According to the unified standards of the whole province, if the medical expenses of the insured residents exceed 1 10,000 yuan within the policy scope, they will be reimbursed 60% according to the following ratio:110,000 yuan-6,543.8+10,000 yuan (including 6,543.8+10,000 yuan); 65,438+70% for the part above 10,000 yuan; You can reimburse up to 400,000 a year.

During the connection period between poverty alleviation and rural revitalization, preferential policies for serious illness insurance will be implemented for eligible rural poverty-stricken population and key monitoring population included in the scope of protection, and the deductible will be reduced from 1 10,000 yuan to 1 10,000 yuan; Within the policy scope of personal burden, the reimbursement rate of medical expenses is-6,543.8+10,000 yuan (including 6,543.8+10,000 yuan), 85% of which is partially reimbursed, and 95% of which exceeds 6,543.8+10,000 yuan; There is no capping line for reimbursement of serious illness insurance during the year.