Jinan divides the proportion of medical insurance reimbursement for employees into two standards according to the types of hospitals. On-the-job staff, who live in a tertiary hospital, will be reimbursed for the part between the deductible line of hospitalization expenses and 1 1,000 yuan, with the reimbursement ratio of 85%; The reimbursement rate for hospitalization expenses between RMB 6,543.8+0,000 yuan and RMB 400,000 yuan is 93%. It should be noted that the reimbursement rate of retirees in hospital is slightly higher than that of on-the-job employees. For example, for retirees, when the hospitalization expenses reach 400,000 yuan, the reimbursement ratio is 3% higher than that of on-the-job personnel; More than 400,000, consistent with the on-the-job personnel, all of which are 90%. According to the types of hospitals, Jinan divides the medical insurance deductible line for employees into three standards, among which: the deductible line for first hospitalization in tertiary hospitals is 1000 yuan; Secondary and primary hospitals, the first hospitalization Qifubiaozhun is 400 yuan; In community hospitals, the threshold for first hospitalization is 200 yuan.

What drugs are not covered by the basic medical insurance reimbursement?

1, which is mainly a tonic drug;

2, some medicinal animals and animal organs, dried (water) fruit;

3. Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces;

4. Fruity preparations and oral effervescent agents in various drugs;

5 blood products and protein products (except for special indications and first aid and rescue);

6, the provisions of the administrative department of social insurance basic medical insurance fund does not pay for other drugs.

Medical insurance settlement procedures:

1, settlement procedures for inpatient and outpatient treatment of special diseases. Designated medical institutions shall submit the expense list, hospitalization list and related materials of discharged patients last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the overall expenses for hospitalization and special disease outpatient service last month. Insured persons suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

2. Emergency settlement procedures. The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

3, the placement of personnel placement procedures. The off-site staff placed in different places shall be designated by their units as designated medical institutions with the residence of 1-2, and reported to the medical insurance agency for the record. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution in their place of residence shall be paid in advance by themselves or their units. After the treatment, the unit holding the insured's diagnosis and medical records, effective bills, compound prescriptions and hospitalization expenses list shall settle the accounts with the social medical insurance agency on the specified date.

4. Referral and settlement. If the insured person is transferred to other medical institutions for diagnosis and treatment due to the conditions of designated medical institutions or specialized diseases, it is necessary to fill in the referral approval form. The reason for referral and transfer is put forward by the attending physician, the director of the department puts forward the opinion of referral and transfer, the medical institution's medical insurance office reviews it, the dean in charge signs it, and it is reported to the municipal medical insurance center for approval before it can be transferred to the hospital for referral and transfer. The city's referral regulations are carried out between designated medical institutions. The referral outside the city is proposed by the designated medical institutions above Grade III in this Municipality. The medical expenses incurred after the insured person is referred to another hospital shall be paid by the individual or unit in cash. After the end of medical treatment, the insured person or his agent will submit the referral approval form, medical record certificate, prescription and valid documents to the medical insurance agency for reimbursement of hospitalization expenses that fall within the scope of the overall fund payment.

Legal basis:

"People's Republic of China (PRC) social insurance law" thirtieth the following medical expenses are not included in the scope of payment of the basic medical insurance fund:

(a) shall be paid from the industrial injury insurance fund.

(2) borne by a third party.

(three) shall be borne by the public health.

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

People's Republic of China (PRC) social insurance law

Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.