20 19 scope of medical insurance reimbursement in Jilin province
1, outpatient and emergency medical expenses
During the year, the medical expenses of on-the-job employees who meet the basic medical insurance coverage totaled more than 2,000 yuan;
3, the insured should be properly kept in the designated hospital outpatient medical documents, as a medical expense reimbursement certificate;
4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Beijing Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement;
5. Hospitalization
Hospitalization deposit: when the insured who meets the hospitalization conditions is hospitalized, the hospital will collect part of the deposit of the insured, and the amount of the deposit will be determined by the hospital according to the illness. If the dispatched personnel unit and the insured fail to pay the medical insurance premium in full and on time, the hospitalization deposit shall be paid in full by the dispatched personnel.
Proportion of medical insurance reimbursement in Jilin Province from 2065438 to 2009
First, adjust the annual maximum payment limit of hospitalization medical expenses for urban residents' basic medical insurance, and uniformly raise it to 1.6 million yuan.
Second, unify the individual qifubiaozhun for urban residents' hospitalization medical expenses, and adjust it to 400 yuan, 800 yuan, 1 100 yuan respectively according to the first-class and lower, second-class and third-class medical institutions.
Three, hospitalization medical expenses in proportion to reimbursement. Hospitalization in first-class and below medical institutions is not segmented, and 1 yuan-160000 yuan will be reimbursed 85%; Of those hospitalized in secondary medical institutions, 70% were 1 yuan-60,000 yuan, and 75% were1yuan-160,000 yuan; In tertiary medical institutions, 1 yuan -30000 yuan is 55%, 3000 1 yuan -60000 yuan is 60%, and 6000 1 yuan-0/60000 yuan is 65%. See the attached table for details of specific expenses and reimbursement ratio.
According to the unified requirements of the whole province, the financing standard of the urban residents' serious illness insurance fund is 30 yuan per person per year, which is extracted from the government subsidy funds in that year. Insured residents meet the prescribed hospitalization medical expenses. After the reimbursement of basic medical insurance, if the individual pays more than 9,600 yuan, the serious illness insurance fund will reimburse by stages: 0- 1 10,000 yuan is 50%, and the reimbursement ratio will increase by 1% for every increase of110,000 yuan; 5-65438+100,000 yuan to report 65%; 10-300,000 yuan, 80%. The maximum annual reimbursement amount is 300,000 yuan.
The above data are estimated according to the information published by the Internet and official website. Specific policies shall be subject to the implementation of the final document. Please consult Jilin Social Security Center on weekdays.
Jilin province labor resources social security bureau
Address: Xuzhou West Road 10, Longtan District, Jilin Province
Public telephone number: 043 1-