Designated hospitals for medical insurance in Guangzhou refer to the list of hospitals with social security medical qualifications published by the social security department. According to the published list, the insured chooses their own hospitals for medical treatment, and then after passing the examination by the social security department, they will issue medical insurance cards to medical insurance participants. With the medical insurance cards, they can go to the designated hospitals for medical treatment, and they can reimburse medical expenses according to relevant regulations, otherwise they will not be reimbursed.

Hospitals are divided into Class A hospitals and Class B hospitals. Class A hospitals are divided into Class I, Class II and Class III hospitals.

In general, each person can choose two designated hospitals for medical insurance, including one compulsory community hospital.

the proportion of hospitalization reimbursement in designated hospitals in Guangzhou-the threshold is low, and the proportion of co-ordination fund in * * * payment period is the highest, while the proportion of individual payment is the lowest

The level of medical insurance units selected is different, and the deductible line, reimbursement amount of co-ordination fund and individual payment amount of hospitalization are quite different. Guangzhou Renai Tianhe Hospital is classified as a first-class hospital (that is, a community service institution), which can enjoy the technical and service standards of a third-class hospital. At the same time, it is also the hospital with the lowest minimum hospitalization qifubiaozhun, the highest proportion of * * * payment period as a whole fund, and the lowest proportion of individual payment. Proportion of hospitalization reimbursement in first-class hospitals: the lowest deductible line is 2 yuan, and the highest deductible line is 4 yuan

. The highest reimbursement rate is 9% with pooling funds, and the individual only needs to pay 1%

. Proportion of hospitalization reimbursement in second-class hospitals: the lowest deductible line reaches 4 yuan, and the highest deductible line is 8 yuan

. The highest reimbursement rate is 85% with pooling funds, and the individual needs to pay 15%

. Proportion of hospitalization reimbursement in third-class hospitals: The maximum fluctuation line is 1,6 yuan

8% of the total fund will be reimbursed, and 2% will be paid by individuals

Calculation formula of hospitalization medical insurance

Calculation formula of hospitalization medical insurance (taking 1 yuan as an example):

Formula 1: hospitalization deductible line+(1-hospitalization deductible line) × individual payment ratio = individual out-of-pocket expenses

Formula 2.

out-of-pocket expenses (that is, within the scope of the three catalogues of medical insurance drugs, diagnosis and treatment items and medical service facilities, it is stipulated that the insured person should pay part of the expenses first);

expenses below the minimum threshold;

*** Pay out-of-pocket expenses;

Expenses exceeding the maximum payment limit of Medicaid for major diseases

References:

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