Sichuan Suining Medical Insurance Reimbursement Scope

Payment policy of medical insurance for urban and rural residents

Included in Suining primary medical institutions (attachment 1) and Suining county (district) level (secondary) medical institutions (attachment 2) for the first time (new diseases will be implemented later), and the payment policy of hospitalization basic medical insurance is as follows.

(a) in the corresponding medical institutions for the first diagnosis and hospitalization, Qifubiaozhun, payment ratio in accordance with the Suining Municipal People's Government Office on printing and distributing the implementation measures of basic medical insurance for urban and rural residents in Suining (Trial) Notice "(Sui Fu Ban Han [2013]189).

(II) If the corresponding medical institution accepts the first diagnosis and hospitalization (out-patient diseases that meet the conditions of upward transfer) and then transfers it to a higher-level medical institution for hospitalization, it will be transferred to the hospital to calculate the Qifubiaozhun according to the standard deviation of secondary medical institutions, and the payment ratio will be in accordance with the Notice of Suining Municipal People's Government Office on Printing and Distributing the Implementation Measures of Suining's Basic Medical Insurance for Urban and Rural Residents (for Trial Implementation) (Sui Fu Ban Han [20 13)

(III) If a superior medical institution is transferred to a primary medical institution for hospitalization, the payment standard will not be counted when it is transferred, and the payment ratio will be increased by 5% on the basis of the medical insurance policy, that is, the payment ratio for the first payment is:

95% community health service centers and township hospitals;

90% of central hospitals;

80% of first-class and non-first-class hospitals;

75% of secondary hospitals;

70% of secondary hospitals;

65% of tertiary and secondary hospitals.

The proportion of payment according to the second payment method is:

95% of community health service centers, township hospitals and central hospitals;

85% of first-class and non-first-class hospitals;

80% of secondary hospitals;

75% of secondary hospitals and 70% of tertiary hospitals.

This article is applicable to the first batch of diseases that are not included in Suining City and transferred from superior medical institutions to primary medical institutions for hospitalization.

(4) If the treatable species of primary medical institutions and the treatable species of municipal, county (district) and grade (secondary) medical institutions fail to go directly to the higher-level medical institutions in the city (outside) for hospitalization, the minimum qifubiaozhun and reimbursement ratio shall be adjusted as follows: if they are directly hospitalized in the higher-level medical institutions in the city, the minimum qifubiaozhun shall be 800 yuan, with the first payment ratio of 45% and the second payment ratio of 50%.

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