Within a medical year, the minimum threshold for hospitalization of urban residents' basic medical insurance is: 200 yuan, 400 yuan and 800 yuan for the first time, halved for the second time, and no minimum threshold is set for the third time.
The annual maximum payment limit of the urban residents' basic medical insurance pooling fund will be raised to 60,000 yuan.
In the basic medical insurance for urban residents, the individual pays 15% for the expenses of using "Class B" drugs and the treatment items that pay part of the expenses, and 20% for using imported medical materials.
Proportion of medical insurance reimbursement for on-the-job employees:
1. After the emergency treatment in the hospital, the medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;
2. If it is a retiree under 70 years old,1.The expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%;
3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed.
No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan.
When hospitalization expenses are paid by basic medical insurance for the first time in a year, the minimum payment for employees and retirees is 1300 yuan.
And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.
The hospitalization reimbursement standard is related to the hospital level where the insured lives:
If you live in a tertiary hospital.
1, from qifubiaozhun to 30,000 yuan, the employee pays 15%, which means 85% reimbursement;
2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;
3. 95% of the part exceeding the maximum payment limit of 40,000 yuan can be reimbursed, as long as the employee pays 5%;
4. Retirees pay 60% of the employees.
Legal basis:
People's Republic of China (PRC) social insurance law
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.