The proportion of medical insurance reimbursement is as follows: the proportion of medical insurance hospitalization reimbursement for employees is185% of hospitalization expenses between 300 yuan and 30,000 yuan; The reimbursement rate is 90% for 30,000-40,000 yuan, 95% for 4 4- 10/00,000 yuan and 85% for10-300,000 yuan. The reimbursement rate of residents' medical insurance is 65% in first-class hospitals, and 80% in second-class hospitals with more than 6000 yuan.
Proportion of hospitalization reimbursement for Lanzhou employees' medical insurance
1. The medical insurance fund of the first-class designated medical institution pays 90%;
2 two designated medical institutions to co-ordinate the cost of medical insurance fund to pay 85%;
3 three designated medical institutions to co-ordinate the cost of medical insurance fund to pay 65%.
In addition, employees who participate in the basic medical insurance for employees who are hospitalized in different places (except first aid and rescue) need to go through relevant procedures such as declaration, examination and approval, review and filing. The hospitalization expenses incurred are formulated by the Municipal Medical Insurance Bureau and approved by the Municipal People's Social Security Bureau, and paid according to different situations and proportions.
The proportion of medical insurance reimbursement for employees in Lanzhou City, the minimum payment standard is adjusted to per person per time 10 yuan, and the annual cumulative capping line is 300 yuan. The proportion of overall reimbursement is adjusted from 50% to 60%, and the cumulative payment of overall reimbursement per person per year is adjusted from 125 yuan to 174 yuan. Precautions: The outpatient co-ordination settlement business of employees' basic medical insurance is limited to designated community health service centers (stations) and some first-class medical institutions (including unrated public grassroots professional health institutions).
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency 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.