"Basic medical insurance" patients: calculated according to a medical insurance year (65438+ 101-65438+February 3 1). The reimbursement standard is:
Deductible-30,000 yuan, 85% paid by the overall fund and 0/5% paid by the individual;
30,000-40,000 yuan, 90% from the overall fund and10% from the individual;
40,000-70,000 yuan, 95% paid by the overall fund and 5% paid by individuals;
70,000 yuan-6,543.8+0.7 million yuan, 70% for large mutual funds and 30% for individuals;
For the part of 654.38 yuan+7,000 yuan or more, the individual pays 654.38+0.000%.
2. The proportion of medical expenses reimbursement for retirees during hospitalization.
"Basic medical insurance" patients: calculated according to a medical insurance year (65438+ 101-65438+February 3 1). The reimbursement standard is:
Deductible-30,000 yuan, 9 1% overall fund payment, 4.5% individual payment and 4.5% supplementary fund payment;
30,000-40,000 yuan, 94% from the overall fund, 3% from the individual and 3% from the supplementary payment;
For the part of 40,000-70,000 yuan, the overall fund pays 97%, the individual pays 1.5%, and the supplementary pays1.5%;
70,000 yuan-6,543.8+0.7 million yuan, 70% for large mutual funds and 30% for individuals;
For the part of 654.38 yuan+7,000 yuan or more, the individual pays 654.38+0.000%.
3, "serious illness insurance for the elderly" during hospitalization medical expenses reimbursement ratio
Patients with "serious illness medical insurance for the elderly": calculated according to a medical insurance year (65438+ 101-65438+February 3 1). The reimbursement standard is:
Deductible-70,000 yuan, 60% paid by medical insurance fund for serious illness and 40% paid by individuals;
The individual pays more than 70,000 yuan (including outpatient special disease expenses) 100%.
4, "medical insurance for serious illness of urban residents" medical expenses reimbursement ratio during hospitalization
"Medical insurance for serious illness of urban residents" patients: calculated according to a medical insurance year (65438+ 101-65438+February 3 1). The reimbursement standard is:
Deductible-70,000 yuan, 60% paid by medical insurance fund for serious illness and 40% paid by individuals; The individual pays more than 70,000 yuan (including outpatient special disease expenses) 100%.
5, students and children's serious illness medical insurance during hospitalization medical expenses reimbursement ratio
"Students' and children's serious illness medical insurance" patients: calculated according to one medical insurance year (September of each year 1- August of the following year 3 1). The reimbursement standard is:
The deductible is -654.38+0.7 million yuan, with 70% paid by the medical insurance fund for serious illness and 30% paid by individuals;
For the part exceeding170,000 yuan (including outpatient special disease expenses), the individual pays 100%.
legal ground
"People's Republic of China (PRC) Social Insurance Law" Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.