In 2022, the proportion of medical insurance reimbursement for Wuhan residents can be roughly divided into five categories:

1, general outpatient service;

2, hypertension, diabetes outpatient medication security;

3. Outpatient treatment of serious (chronic) diseases;

4. Hospitalization;

5. critical illness insurance.

Various reimbursement rates are different, and the specific reimbursement rates are as follows:

1, general outpatient service

Reimbursement ratio: the payment ratio of residents' medical insurance fund is 50%.

Reimbursement amount: annual payment limit of 400 yuan.

Qifubiaozhun: There is no Qifubiaozhun for residents in community health service centers (without medical grade), township hospitals, community health service stations and village clinics; Other medical institutions outpatient Qifubiaozhun accumulated 200 yuan throughout the year.

Note: The medical expenses for prenatal check-up in outpatient clinics that meet the requirements of fertility are calculated together with those in general outpatient clinics, and the relevant provisions of general outpatient clinics are implemented.

2, hypertension, diabetes outpatient medication security

Reimbursement ratio: within the range of 50% of the overall fund payment ratio.

Reimbursement amount: the maximum monthly payment limit for hypertension is 30 yuan; The maximum monthly payment limit for diabetes is 40 yuan; The monthly payment limit for "two diseases" is 50 yuan.

3, outpatient treatment of severe (chronic) diseases

Reimbursement ratio: the basic medical insurance fund pays 50%; The proportion of phenylketonuria compensation is 70%.

Reimbursement amount: the annual payment limit of the basic medical insurance fund is 4,000 yuan to 1.5 million yuan. Insured persons who have undergone radiotherapy and chemotherapy for malignant tumors (including leukemia), chronic renal failure requiring renal dialysis treatment, anti-rejection after kidney transplantation and anti-rejection after liver transplantation can pay a maximum of 300,000 yuan.

4. Hospitalization

Reimbursement ratio: the basic payment ratio of first-class medical institutions (if the level of community health service center is higher than the first level, the first-class standard shall be implemented) is 90%, and the deductible standard for first hospitalization, second hospitalization and above is 200 yuan; The basic payment ratio of secondary medical institutions is 70%, of which the first hospitalization deductible standard is 400 yuan, and the second and above hospitalization deductible standards are 200 yuan; The basic payment ratio of tertiary medical institutions is 60%, of which the first hospitalization deductible standard is 800 yuan, and the second and above hospitalization deductible standards are 200 yuan.

Note: (1) The medical expenses incurred by using Class B drugs and Class B diagnosis and treatment projects are paid by the individual10%; The hospitalization expenses incurred by medical treatment in different places are paid by the individual10%; The use of special drugs, in accordance with the relevant laws and regulations of medical insurance payment standards and the proportion of the first self-payment, and then according to the relevant laws and regulations of the payment management of Class B drugs.

(II) The transfer between designated medical institutions (departments) shall be regarded as a hospitalization, and the Qifubiaozhun for high-grade medical institutions shall be implemented, and the proportion of hospitalization payment for transfer-out and transfer-in medical institutions shall be implemented respectively.

(three) the medical expenses of hospital delivery in accordance with the maternity regulations shall be paid by the residents' medical insurance fund according to the highest 700 yuan/time standard.

(4) After the outpatient emergency rescue was hospitalized, the emergency rescue expenses were included in the hospitalization expenses.

(5) In an insurance year, the maximum payment limit of basic medical insurance is 6.5438+0.5 million yuan.

5. critical illness insurance

Reimbursement ratio: within an insurance year, the amount of personal burden that meets the scope of serious illness insurance is calculated cumulatively, reimbursed by stages and settled by time.

1.20,000 yuan, 30,000 yuan and the following accumulated amount is 60%; The compensation ratio from 30,000 yuan to 6,543,800 yuan and below is 65%; The compensation ratio of 65438+ 10,000 yuan is 75%.

Qifubiaozhun: Personal burden1.20,000 yuan that meets the coverage of serious illness insurance. The above part of Qifubiaozhun shall be reimbursed by serious illness insurance in proportion.

Note: The annual maximum payment limit is 300,000 yuan. In an insurance year, each insured patient only deducts the minimum payment for critical illness insurance once.

Legal basis:

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

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.