Provisions on reimbursement of serious illness in Qingdao residents' medical insurance outpatient service:
1. Qifubiaozhun: 300 yuan, a community health service institution, 500 yuan, a first-class hospital, 670 yuan, a second-class hospital and 840 yuan, a third-class hospital.
2. Reimbursement ratio: 75% for designated medical institutions in the community and 65% for designated hospitals;
3, more than the disease limit standard above part will not be paid.
4. Children/college students: the minimum threshold for tertiary medical institutions is 500 yuan, and the secondary and below medical institutions are 300 yuan.
5, uremia dialysis treatment, organ transplantation anti-rejection treatment, leukemia, malignant tumor patients with radiotherapy and chemotherapy outpatient medical expenses without a separate Qifubiaozhun, basic medical insurance fund payment standards in accordance with the hospitalization standards.
Twenty-seventh "Qingdao social medical insurance measures"
Qifubiaozhun refers to the hospitalization and outpatient medical expenses paid by the basic medical insurance pooling fund. The qifubiaozhun of the first, second and third-level designated medical institutions are 200 yuan, 500 yuan and 800 yuan respectively, and the qifubiaozhun of the designated community medical institutions is implemented according to the first-level designated medical institutions. If the insured is hospitalized for the first time within one year, the Qifubiaozhun shall be implemented according to 100%; The second hospitalization, Qifubiaozhun by 50%; For those hospitalized for the third time or more, the Qifubiaozhun shall be uniformly implemented according to 100 yuan. Insured outpatient treatment of serious illness, in a year to bear a Qifubiaozhun.
Second, the impact of outpatient treatment of serious illness
The basic medical expenses and local supplementary medical expenses incurred by the partners who enjoy the treatment of serious illness outpatient service can be reimbursed, but the reimbursement ratio is related to the time you have been insured continuously. If these two expenses cost 20,000 yuan when you are sick, and you have participated in medical insurance for more than 36 months, and the reimbursement rate is 90%, then you can reimburse18,000 yuan. But if one day it breaks down and the payment period is cleared, the reimbursement ratio will become 60%, and you can only reimburse 12000 yuan, which costs 6000 yuan more.
Three, what is the outpatient medical insurance reimbursement?
The new rural cooperative medical system covers 20 major diseases such as childhood leukemia, congenital heart disease, severe mental illness, breast cancer, cervical cancer, end-stage renal disease, multidrug-resistant tuberculosis, AIDS opportunistic infection, lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction, cerebral infarction, hemophilia, type I diabetes, hyperthyroidism and cleft lip and palate.
Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by individuals;
Reimbursement ratio: minimum payment for the first hospitalization in a natural year 1.300 yuan, each time in 650 yuan. The payment ratio is divided into three grades. Take a tertiary hospital as an example. The floating standards are: 30,000 yuan, 85% on the job, 9 1% for retirement, 90% for 30,000-40,000, 94% for retirement, more than 40,000, 95% for employment and 97% for retirement. 90 days of general hospitalization is a settlement cycle. Psychiatric hospitalization for 360 days is a settlement cycle, and the floating standard is halved. In a natural year, the overall fund pays a maximum of 70,000 yuan. The maximum hospitalization amount is 654.38+10,000 yuan, and the hospitalization ratio is 70%;
Medical management: if the unit pays the full fee, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment. The medical expenses incurred should conform to the scope of the three major catalogues of medical insurance;
Reimbursement process: At the time of discharge, the hospital and the individual will settle the self-funded and self-funded amount, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.
Twenty-seventh "Qingdao social medical insurance measures"
Qifubiaozhun refers to the hospitalization and outpatient medical expenses paid by the basic medical insurance pooling fund. The qifubiaozhun of the first, second and third-level designated medical institutions are 200 yuan, 500 yuan and 800 yuan respectively, and the qifubiaozhun of the designated community medical institutions is implemented according to the first-level designated medical institutions. If the insured is hospitalized for the first time within one year, the Qifubiaozhun shall be implemented according to 100%; The second hospitalization, Qifubiaozhun by 50%; For those hospitalized for the third time or more, the Qifubiaozhun shall be uniformly implemented according to 100 yuan. Insured outpatient treatment of serious illness, in a year to bear a Qifubiaozhun.