1, above the deductible line to 50,000 yuan: 55% reimbursement;
More than 25,000 yuan to 6,543,800 yuan: 65% reimbursement;
3. 65,438+10,000 yuan to 200,000 yuan: 75% reimbursement;
4, more than 200,000 yuan to 300,000 yuan: 80% reimbursement;
More than 53,000 yuan: 55% reimbursement; Reimbursement 85%.
6. Secondary compensation: after the hospitalization expenses are reimbursed by the urban and rural residents' serious illness insurance fund according to the regulations, eligible individuals pay more than 50,000 yuan, and then reimbursed at a rate of 50%.
For example, Mr. Zhang meets the conditions for reimbursement of serious illness medical insurance in Linfen. He is treated in a designated medical insurance hospital with a minimum payment of 200,000 yuan and can be reimbursed 75%. The calculation result is that he can reimburse 1.5 million yuan.
Linfen medical insurance reimbursement ratio:
Shanxi Provincial Department of Human Resources and Social Security has learned that the province has adjusted its medical insurance policy, and the average reimbursement rate of total expenses in the medical insurance catalogue for urban and rural residents has increased to 80%, benefiting 26 million urban and rural insured persons.
After the adjustment, Shanxi Province unified the basic medical insurance payment standard for urban and rural residents, and rural residents and urban residents implemented a unified medical insurance drug list. At the same time, Shanxi province canceled the previous subsection compensation method for serious illness insurance. The part of the insured person's hospitalization expenses in the medical insurance catalogue that the individual pays 1 10,000 yuan or more shall be paid by the serious illness insurance fund at a unified rate of 75%. The maximum payment amount of the serious illness insurance fund for insured patients within one year is 400,000 yuan. During the year, the guiding cap line for urban and rural residents' basic medical insurance pooling fund to pay hospitalization expenses was 70,000 yuan, and the deductible standard for reimbursement of hospitalization expenses for the insured after the second time in the year was 50% lower than the current deductible standard.
After the adjustment, the minimum payment standard and payment ratio of basic medical insurance for hospitalization expenses in Shanxi Province are unified in the whole province. The specific standards are: first-class hospital (first-class charging standard): the deductible line of hospitals outside the province is 1500 yuan, and the payment ratio is 55%; The deductible line of provincial and municipal hospitals in the province is 1000 yuan, and the payment ratio is 60%. Third-class B and second-class A hospitals (second-class charging standard): 500 yuan, the deductible line of provincial and municipal hospitals, with a payment ratio of 70%; The deductible line of county-level hospitals is 400 yuan, and the payment ratio is 75%. Second-level hospital (third-level charging standard): deductible line 100 yuan, and the payment ratio is 85%.
The above information comes from network collection. Please consult Linfen Social Security Center for details.
legal ground
Social insurance law
Article 28
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.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.