1. Proportional standard of medical insurance reimbursement expenses for employees in Liaoning 1. The hospitalization expenses of insured residents within the policy scope of designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.

2. Insured residents are hospitalized in designated medical institutions at the provincial level, and the Qifubiaozhun is determined according to about 10% of the average hospitalization expenses of each designated medical institution at the provincial level in the previous year, not less than 1500 yuan. Within the scope of the policy, the proportion of hospitalization medical expenses paid shall not be less than 50%. The specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of the medical insurance fund for urban and rural residents in the overall planning areas and the medical conditions of the insured residents.

3. The medical insurance fund for urban and rural residents sets the maximum payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million yuan.

Second, Liaoning medical insurance reimbursement process and required materials First, hospitalization reimbursement process

First, you need to show your medical insurance card, and then pay according to the regulations of the hospital. After discharge, you can go to the hospital medical insurance office to settle accounts and enjoy medical insurance benefits.

Second, the reimbursement process for hospitalization in different places

(1), reporting settlement information.

Please bring the following information for reimbursement of hospitalization in different places.

1, hospital invoice (seal)

2. Detailed list of hospitalization expenses (seal)

3. Discharge record (seal)

4, the use of drugs outside the directory and special diagnosis and treatment project copy (seal)

5. Medical insurance card

6, complete procedures of the * * city * * district urban workers medical insurance referral form "

(2) Settlement

The hospitalization procedures in different places are complete, and the reimbursement will be settled with the receipt and my ID card (the consignee needs to provide the consignee ID card) after 5 working days. Reimbursement will be suspended from 28th to the end of each month, and resumed the following month 1 day.

Third, the outpatient reimbursement procedures for critically ill patients

1. reimbursement time

Reimbursement time of hypertension and diabetes in critical outpatient department: 1 quarter March; The second quarter is June; The third quarter is September; The fourth quarter is 65438+February.

The outpatient department of other diseases is reimbursed once a month.

2. Declare settlement information

1 outpatient medical receipt;

2, Chinese prescription unit price and seal;

3. Check the original attached inspection report.

Settle accounts

After completing the formalities, the reimbursement amount will be directly transferred to my bank passbook after 5 working days.