Proportion of medical insurance reimbursement for employees in Xiantao City

The reimbursement ratio of medical insurance for employees in Xiantao City is as follows:

1, outpatient treatment of severe diseases: outpatient dialysis of chronic renal failure; Outpatient anti-rejection drugs included in the scope of medical insurance payment after organ transplantation; Outpatient chemotherapy, interventional therapy, radiotherapy or radionuclide therapy for malignant tumors; Hemophilia specialist outpatient treatment; Specialized outpatient treatment of aplastic anemia; Special outpatient treatment of thalassemia; Outpatient treatment of other serious diseases such as intracranial benign tumors.

2. After going to the general outpatient department of the hospital, the minimum threshold is 1.800 yuan's medical expenses can be reimbursed, and the reimbursement rate is 50%.

For retirees under the age of 3.70, the expenses above 65,438 yuan +0.300 yuan can be reimbursed, and the reimbursement ratio is 70%.

4. Retirees over 70 years old,1.Expenses above 300 yuan can be reimbursed, and the reimbursement rate is 80%.

The medical insurance reimbursement process for employees in Xiantao City is as follows:

1, the insured person submits relevant materials to the medical insurance service hall.

2 medical insurance service hall handling personnel to accept the materials required for the declaration and conduct a preliminary examination. If the materials are incomplete, inform them at one time, and if the materials are complete, register the ledger and enter the expenses into the medical insurance information system for settlement.

3. After the audit settlement is completed, sort out the original materials, financial disbursement summary table and patient bank information statistics table, and report them to the handling personnel for audit.

4, in charge of the person in charge of the audit, the "fee settlement disbursement form" to the financial sector, according to the provisions of the disbursement to the insured patient's bank card (account).

5. After the payment is completed, the successful payer will notify the payee according to the telephone number reserved by the insured. In case of refund, you will contact the insured by phone and recheck the information of the collection account.

The benefits of medical insurance include the following aspects:

1, low payment and high security: the medical insurance payment standard is low and the security degree is high. The combination of individual contributions and financial subsidies ensures the basic medical needs of the insured.

2. Wide coverage: medical insurance covers a wide range of people, including urban workers, urban and rural residents, flexible employees, etc., achieving the goal of universal coverage.

3. Low threshold: the threshold of medical insurance is low, and there are no restrictions on age, occupation and health status. Anyone who meets the conditions for insurance can participate in medical insurance.

4. High reimbursement rate: The reimbursement rate of medical insurance is high, and the scope of reimbursement is wide, including drugs, diagnosis and treatment, service facilities and other aspects, which reduces the medical burden of patients.

5. Convenient and fast: the medical insurance reimbursement process is simple and fast, and patients can directly settle accounts in hospitals or go through reimbursement procedures through medical insurance agencies, which is convenient and fast.

6. Reduce the burden: The payment and reimbursement policy of medical insurance can effectively reduce the medical burden of individuals and families, especially in the face of serious diseases, chronic diseases and other situations that require long-term treatment, and the role of medical insurance is more significant.

7. Long-term security: The payment period of medical insurance can be calculated cumulatively, and long-term insured persons can enjoy a higher level of medical security benefits after reaching the statutory retirement age.

To sum up, medical insurance is an important social security system, which can provide comprehensive, convenient and efficient medical security services for the insured and protect the basic medical rights and interests of the people.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses 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.