Proportion of medical insurance reimbursement in Qifu Hospital

The proportion of medical insurance reimbursement in Qifu Hospital is generally between 50% and 90%.

The proportion of medical insurance reimbursement is usually divided into two parts:

1, basic medical insurance reimbursement ratio;

2. Supplementary medical insurance reimbursement ratio.

The coverage of medical insurance is as follows:

1. Personal burden of medical insurance medical expenses: hospitalization during the insured year, including personal burden of compliance medical expenses within the scope of family beds and outpatient medical insurance for specific diseases. The insured amount is 6,543.8+0,000 yuan, the deductible is 20,000 yuan, the reimbursement rate is 80%, and the reimbursement rate for going out of the city for medical treatment is 30%;

2. Compensation for personal expenses outside medical insurance: individuals outside the scope of medical insurance catalogue bear compliance medical expenses. The insured amount is 6,543.8+0,000 yuan, the deductible is 20,000 yuan, the reimbursement rate is 60%, and the reimbursement rate for going out of the city for medical treatment is 30%;

3. Compensation for self-funded drugs for malignant tumors: 90% of self-funded drugs for malignant tumors and self-funded drugs that meet corresponding indications are reimbursed by the insured during the insurance year, and 60% of those who have suffered from malignant tumors before the first insurance;

4. Compensation for ultra-high medical expenses: 90% of the medical expenses within the medical insurance catalogue that have been compensated by basic medical insurance, serious illness insurance and commercial medical insurance during the insured year will be reimbursed. 250,000 yuan to 6,543,800 yuan, 654.38+000% reimbursement;

5. Compensation for high medical expenses of general outpatient service: the high medical expenses borne by the general outpatient service of designated medical institutions in Foshan City or those who have been referred for filing or live in different places during the insurance year. The insured amount is 654.38 million yuan, the deductible is 20,000 yuan, and the reimbursement ratio is 60%;

6. The continuous insured has no claim preferential treatment, with 28 kinds of serious illness insurance premium of 65,438+0,000,000, and 65,438+0,265,438+0 kinds of rare illness insurance premium.

To sum up, medical security departments at all levels should orderly promote the convergence of work before and after the transfer of medical insurance fee collection and management responsibilities for urban and rural residents, and ensure that the annual financing quantitative indicators are put in place.

Legal basis:

Article 27 of People's Republic of China (PRC) Social Insurance Law

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 60

The employing unit shall declare itself and pay social insurance premiums in full and on time, and shall not postpone or reduce the payment except for legal reasons such as force majeure. The social insurance premiums that employees should pay shall be withheld and remitted by the employer, and the employer shall inform me of the details of paying social insurance premiums on a monthly basis.

Individual industrial and commercial households without employees, part-time employees who have not participated in social insurance in the employing units and other flexible employees can pay social insurance premiums directly to the social insurance premium collection agencies.