Proportion of medical insurance reimbursement for surgical expenses
First, the proportion of outpatient and emergency expenses reimbursement
1. The medical expenses above 1800 yuan can only be reimbursed after the on-the-job employees see a doctor in the emergency department of the hospital, and the reimbursement rate is 50%.
2. Retirees under the age of 70,1.Expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%.
3. Retirees over 70 years old,1.Expenses above 300 yuan can be reimbursed by 80%.
Second, the proportion of hospitalization expenses reimbursement
The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.
1, the standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. If you live in a tertiary hospital, the employee pays 15%, which is 85% of the reimbursement, from the minimum threshold to 30,000 yuan.
2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;
3, more than 40000 yuan to the maximum payment limit, 95% can be reimbursed, employees only need to pay 5%.
4. The individual contribution ratio of retirees is 60% of the on-the-job (i.e. the above) employees, but all below the threshold is paid by individuals.
The scope of medical insurance reimbursement for surgical expenses
1, artificial organs such as pacemakers, artificial joints, intraocular lenses and vascular stents replaced in vivo, and materials placed in the body;
2. Kidney, valve, cornea, skin, blood vessels, bones and transplantation;
3. Laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects;
4. Hemodialysis and peritoneal dialysis.
Scope of non-reimbursement of surgical expenses
1, the organ source or tissue of various organ or tissue transplants;
2, all kinds of beauty, bodybuilding projects and non-functional cosmetic surgery;
3, myopia orthopedic active medical behavior will not be reimbursed, such as plastic surgery, orthopedic surgery, etc. In order to make your appearance conform to your own ideas, whether you look good or not does not affect your health, but if you feel bad, you have to have surgery. The role of insurance is to protect and protect one's health, and social security resources are all owned and scarce, so this kind of active medical treatment will not be reimbursed. Passive medical behavior: the patient was diagnosed in a public hospital above the second level, and the hospital required to treat the patient. This can be reimbursed. What can be reimbursed? Prefecture-level cities have a "social security drug reimbursement list", which can be seen clearly.