Proportion of medical insurance reimbursement for urban and rural residents
Primary and secondary school students and babies:
Emergency department (including family sickbed)
1, outpatient and emergency qifubiaozhun 300 yuan;
2, the village clinic excluding Qifubiaozhun;
3, Qifubiaozhun below the medical expenses, paid by individuals; 4, more than Qifubiaozhun above medical expenses, a hospital to pay 30%, personal insurance fund to pay 70%; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
Hospitalization (including observation in emergency observation room)
1. The minimum threshold of medical expenses per hospitalization is: 50 yuan, a first-class hospital; 100 yuan, a second-class first-class hospital; 300 yuan, a third-class first-class hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than Qifubiaozhun above medical expenses, a hospital to pay 20%, home insurance fund to pay 80%; Secondary hospitals are responsible for 25%, and residential insurance funds pay 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
College students:
Emergency department (including family sickbed)
1. On-campus outpatient service: At least 90% of the medical expenses incurred by on-campus outpatient service shall be paid by institutions, and the rest shall be borne by individuals;
2. Out-of-school outpatient service and emergency treatment: it is paid according to the outpatient service and emergency treatment of primary and secondary school students in residential insurance. Specifically, the deductible line for outpatient service and emergency treatment is set in 300 yuan, and the part exceeding the deductible line is paid by annual accumulation: 30% for the first-class hospital and 70% for the residential insurance fund; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
In-patient and emergency observation rooms for in-patient observation
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than Qifubiaozhun above medical expenses, a hospital to pay 20%, home insurance fund to pay 80%; Secondary hospitals are responsible for 25%, and residential insurance funds pay 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
People aged 65-438:
Emergency department (including family sickbed)
1, outpatient and emergency qifubiaozhun 500 yuan;
2, the village clinic excluding Qifubiaozhun;
3, Qifubiaozhun below the medical expenses, paid by individuals;
4, more than Qifubiaozhun above medical expenses, a hospital to pay 30%, personal insurance fund to pay 70%; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
Hospitalization (including observation in emergency observation room)
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than Qifubiaozhun above medical expenses, a hospital to pay 20%, home insurance fund to pay 80%; Secondary hospitals are responsible for 25%, and residential insurance funds pay 75%; The third-class hospital pays 40% and the residential insurance fund pays 60%.
People aged 60 to 69:
Emergency department (including family sickbed)
1, outpatient and emergency qifubiaozhun 300 yuan;
2, the village clinic excluding Qifubiaozhun;
3, Qifubiaozhun below the medical expenses, paid by individuals;
4, more than Qifubiaozhun above medical expenses, a hospital to pay 30%, personal insurance fund to pay 70%; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
Hospitalization (including observation in emergency observation room)
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than qifubiaozhun above medical expenses, the level of hospital personal conceit 10%, home insurance fund to pay 90%; Secondary hospitals are responsible for 20%, and the living insurance fund pays 80%; The third-level hospital pays 30%, and the residential insurance fund pays 70%.
People over 70 years old:
Emergency department (including family sickbed)
1, outpatient and emergency qifubiaozhun 300 yuan;
2, the village clinic excluding Qifubiaozhun;
3, Qifubiaozhun below the medical expenses, paid by individuals;
4, more than Qifubiaozhun above medical expenses, a hospital to pay 30%, personal insurance fund to pay 70%; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% and the residential insurance fund pays 80%.
Hospitalization (including observation in emergency observation room)
1. The medical expenses incurred in each hospitalization are set as the minimum payment standard, specifically: 50 yuan, a first-level hospital, 100 yuan, 300 yuan, a third-level hospital;
2, Qifubiaozhun below the medical expenses, paid by individuals;
3, more than Qifubiaozhun above medical expenses, a hospital to pay 30%, personal insurance fund to pay 70%; Secondary hospitals are responsible for 40%, and the living insurance fund pays 60%; Three hospitals pay 50%, and the family insurance fund pays 50%; The village clinic pays 20% by the individual and 80% by the residential insurance fund.
legal ground
Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers
Twenty-seventh employees of the employer who pay the basic medical insurance premiums in accordance with these regulations shall enjoy the basic medical insurance benefits.
Twenty-eighth personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.