As my country’s medical security mechanism gradually improves, people are paying more and more attention to medical insurance information. In recent years, more and more people in Tianjin have participated in medical insurance, and the number of people benefiting from it has also gradually increased. However, many friends are concerned about the Xi'an Medical Insurance reimbursement ratio in 2019 and the Xi'an Medical Insurance reimbursement range. Medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide basic medical needs for workers within the scope of coverage when they fall ill. Xi'an's medical insurance reimbursement ratio in 2019 is divided into three categories, namely urban employee medical insurance, urban residents' medical insurance and new rural cooperative medical insurance. Among them, employee medical insurance is reimbursed in first-level hospitals and community health service institutions: there is no deductible for less than 300 yuan, and reimbursement is 60; the deductible is 80 yuan for more than 300 yuan, and reimbursement is 90%; second-level hospitals: domestic deductible 200 yuan, and the overseas minimum payment is 500 yuan, and reimbursement is based on 70%-80%; tertiary hospitals: the minimum payment is 1,000 yuan, and reimbursement is 50%-60%; community health service institutions in resident medical insurance: the minimum payment is 200 yuan, Reimbursement is based on 60%; first-level hospitals: the minimum payment is 300 yuan, and reimbursement is 85%; second-level hospitals: the minimum payment is 400 yuan, and reimbursement is 75%; 3. Third-level hospitals: the minimum payment is 500 yuan, and reimbursement is 55% Reimbursement; So, what is the reimbursement scope of Xi'an Medical Insurance? First of all, everyone needs to meet the following requirements: 1. Enroll in the insurance and pay normally and the benefit review period has expired (insurance as a unit has paid for 30 days, and as an individual has paid for 6 months); 2. The disease is in line with the "Basic Medical Insurance Hospitalization" "Disease Catalogue"; 3. The information is complete; the scope of reimbursement is: hospitalization (including home beds) of insured employees or residents in designated medical institutions; 2. Expenses incurred by insured persons in designated medical institutions and designated retail pharmacies; In addition, China Minsheng.com provides online insurance for health insurance to buy peace of mind for your health. Xi'an medical insurance reimbursement ratio 2018, Xi'an out-of-town medical insurance reimbursement scope and policy regulations in 2018.

Xi'an Medical Insurance Reimbursement Ratio

Medicare insurance for ordinary urban residents: 50% of outpatient outpatient reimbursement for urban non-employed residents with urban household registration in Xi'an and over 18 years old, with a maximum reimbursement limit of 500 yuan . The maximum reimbursement amount is 140,000. Excluding the deductible, 55% is reimbursed by third-level hospitals, 75% by second-level hospitals, and 85% by first-level and below hospitals.

Reimbursement for children and adolescents: The payment ratio of the unified fund for children and adolescents will be increased by 5% according to the corresponding standards for urban non-employed residents.

Urban employee medical insurance objects: Medical premiums paid by urban employee units and individual employees are partially credited into personal accounts (medical insurance cards) and used to purchase medicines, etc. The maximum reimbursement amount for hospitalization is 400,000 yuan.

New Rural Cooperative Medical System Targets: Farmers in Xi'an will be reimbursed up to 150,000 yuan per person per year, of which hospitalization compensation is up to 130,000 yuan, and the remaining 20,000 yuan is for outpatient and chronic disease reimbursements.

_Employees_

In a statistical year, the minimum payment standard for the overall fund is a certain proportion of the average salary of employees in the city in the previous year, and is set based on the level of the hospital where employees seek medical treatment and the number of hospitalizations. For the portion of hospitalization medical expenses incurred by employees (including retirees) insured by the city's urban employee basic medical insurance in designated medical institutions from more than 50,000 yuan to the maximum payment limit, the personal payment ratio will be adjusted to 5%.

Hospital-level minimum payment standards:

First time: 10% for third-level hospitals, 8% for second-level hospitals, and 6% for first-level hospitals;

Second Second time: 7% of third-level hospitals, 5% of second-level hospitals, and 4% of first-level hospitals;

Third time and above: 5% of third-level hospitals, 4% of second-level hospitals, and first-level hospitals 3%.

The portion of hospitalization medical expenses below the respective minimum payment standards shall be paid from a personal account or paid by the patient himself.

Employees’ personal out-of-pocket ratio:

For above the minimum payment standard and up to 10,000 yuan: 10% for first-level hospitals, 12% for second-level hospitals, and 15% for third-level hospitals;

More than 10,000 yuan to 50,000 yuan: 6% for first-level hospitals, 8% for second-level hospitals, and 11% for third-level hospitals;

From 50,000 yuan to the maximum payment limit: 5% for both;< /p>

The personal payment ratio for retired (employee) personnel shall be reduced by three percentage points according to the corresponding standards for active employees.

Personal out-of-pocket ratio for retirees:

For those above the minimum payment standard up to 10,000 yuan: 12% for first-level hospitals, 9% for second-level hospitals, and 7% for third-level hospitals;

More than 10,000 yuan to 50,000 yuan: 3% for first-level hospitals, 5% for second-level hospitals, and 8% for third-level hospitals;

From 50,000 yuan to the maximum payment limit: 5% for both;< /p>

>>>>Special outpatient items:

1. Outpatient treatment of special diseases (outpatient radiotherapy and chemotherapy for malignant tumors, outpatient renal dialysis, anti-rejection drugs after organ transplantation): overall planning The fund pays 50% and the individual pays 50%.

2. Outpatient treatment of chronic diseases (hypertension, coronary heart disease, diabetes): If the cumulative medical expenses for outpatient treatment of chronic diseases in designated medical institutions in a year exceed 350 yuan, the excess amount will be paid from the pooling fund at the rate of 50 yuan. % standard payment, and the maximum payment limit of the overall fund is 2,000 yuan.

>>>>Hospitalization:

For towns and first-level designated hospitals, if the compliance fee is less than 300 yuan, there is no deductible and 60% of the compliance fee is reimbursed; For more than 300 yuan (including 300 yuan), the minimum payment line is 80 yuan, and the compensation rate is 90%.

For district/county-level and secondary designated medical institutions (including municipal-level designated secondary medical institutions) within the district (county), the minimum payment line is 200 yuan, and outside the district (county) it is 500 yuan, and the compensation The ratio is 70%-80%.

The minimum payment line for municipal-level designated tertiary medical institutions is 1,000 yuan, and the compensation ratio is 50%-60%.

>>>>Reimbursement scope:

1. Insured residents are hospitalized in designated medical institutions (including home beds) for treatment

2. Insured residents are treated in designated medical institutions Expenses incurred by designated medical institutions and designated retail pharmacies

>>>>Seven circumstances cannot be reimbursed

1. Medical expenses incurred at non-designated medical institutions without approval

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2. Except for suicide and self-mutilation (mental illness)

3. Fighting, fighting, alcoholism, drug abuse and other injuries and illnesses caused by crimes or violations of the "Public Security Management Punishment Law"

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4. Traffic accidents, accidental injuries, medical accidents, etc.

5. Treatment due to cosmetology, orthopedics, physiological defects, etc.

6. Work-related injury insurance (including Occupational diseases) or maternity insurance payment scope

7. Other non-payment situations stipulated in national, provincial and municipal medical insurance policies

>>>Reimbursement conditions:

< p>1. Participate in insurance and pay normally (referring to still being insured and paying when discharged) and the benefit review period has expired (insurance and payment as an organization have been completed for 30 days, and insurance and payment as an individual have been completed for 6 months)< /p>

2. The disease category complies with the "Basic Medical Insurance Inpatient Disease Catalog"

3. The information is complete

>>>Reimbursement materials:

< p>1. "Xi'an Basic Medical Insurance Ordinary Hospitalization Permit"

2. Home page of hospitalization medical record (stamped with hospital seal, keep the original)

3. Discharge record (stamped with Hospital seal, keep the original)

4. Diagnosis certificate (stamped with the hospital’s seal, keep the original)

5. Financial notes (stamped with the hospital’s financial seal, keep the original)

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6. Detailed list of expenses (stamped with the hospital seal, keep the original)

7. Personal ID card (check the original, keep the copy)

8. Prepare a A bank card or coupon of the applicant (must be a local card or coupon with general deposit and redemption, and you must know the accurate account opening bank and other information, verify the original, and keep a copy)

9. Entrusted processing Provide the trustee’s ID card (original to be verified)

>>>>Remote medical insurance settlement:

Shaanxi Province basically achieves the settlement of out-of-region medical insurance within the province. At present, employees from various cities in the province have realized direct settlement in different places when they go to Xi'an for medical treatment. Some direct settlements between Xi'an and Xianyang and Ankang have been realized. In the next step, direct settlement between cities will also be realized based on demand.

Xi’an Women’s Maternity Insurance

>>>>The reimbursement conditions of Xi’an Maternity Insurance have the following two conditions:

(1) Childbirth in compliance with the national family planning policy or Perform family planning surgery.

(2) The unit you work for participates in maternity insurance in accordance with regulations and pays the employee in full for more than one year.

The reimbursement scope of maternity insurance includes the following aspects:

If the employer has participated in maternity insurance in accordance with regulations and paid in full and on time, employees (female employees) who give birth in compliance with relevant family planning policies ), can enjoy the following maternity insurance benefits, and a limited subsidy is implemented for maternity medical expenses.

1. Subsidy standards for maternity medical expenses (including prenatal examination fees, delivery fees, blood transfusion fees, surgery fees, hospitalization fees and medicine fees):

7 months of pregnancy (inclusive) For births over 7 months) or premature births less than 7 months of pregnancy, the medical subsidy standards for hospital delivery are:

①The maximum medical subsidy for cesarean section shall not exceed 6,000 yuan

②Yin The maximum subsidy for maternity medical expenses shall not exceed 4,000 yuan

The maximum subsidy for maternity medical expenses shall not exceed 1,000 yuan for spontaneous abortions and artificial terminations of pregnancy over 3 months (inclusive) and less than 7 months of pregnancy.

For spontaneous abortion and artificial termination of pregnancy under 3 months of pregnancy, the maximum subsidy for maternity medical expenses shall not exceed 350 yuan.

2. Other expense subsidy standards related to maternity insurance:

The spouse of a male employee who participates in maternity insurance is a non-urban employee who has not participated in maternity insurance, and the maternity medical expense limit for female employees is based on the limit. 50% of the subsidy is provided as a one-time subsidy by the Maternity Insurance Fund.

For female employees participating in maternity insurance who receive conservative treatment after an ectopic pregnancy, the maximum subsidy standard shall not exceed 4,000 yuan; the maximum subsidy standard for surgical treatment shall not exceed 6,000 yuan.

3. Subsidy for childbirth complications:

For employees who suffer from one of the following complications caused by childbirth, while enjoying maternity insurance benefits, the maximum medical expense subsidy shall not exceed 2,000 yuan. If you suffer from two or more (including 2) reproductive complications at the same time, the maximum medical expense subsidy shall not exceed 3,000 yuan.

Reproductive complications (26 types): pregnancy-induced hypertension, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, maternal and fetal blood group incompatibility, gestational diabetes, uterine rupture, amniotic fluid embolism , postpartum hemorrhage, puerperal infection, postpartum urinary retention, mastitis, hyperemesis gravidarum, contoured placenta, vasa previa, polyhydramnios, oligohydramnios, premature rupture of membranes, intrauterine growth retardation, cervical and vaginal laceration, Uterine inversion, obstetrical shock, obstetrical disseminated intravascular coagulation, amniotic infection syndrome, maternal heatstroke, and mental disorders during pregnancy.

4. Subsidy standards for family planning surgeries:

The maximum subsidy for insertion (removal) of intrauterine devices and subcutaneous implantation (removal of subcutaneous implants) shall not exceed 300 yuan.

The maximum subsidy for sterilization surgery shall not exceed 1,000 yuan.

The maximum subsidy for fallopian tube or vas deferens recanalization surgery shall not exceed 1,500 yuan.

We learned from the Shaanxi Provincial Department of Human Resources and Social Security that in accordance with the overall ideas and short-term goals determined by the three national ministries and commissions, in 2015, our province will basically achieve the settlement of medical insurance in other places within the province. At present, employees from various cities in the province have realized direct settlement in different places when they go to Xi'an for medical treatment. Some direct settlement in other places has been realized from Xi'an to Xianyang and Ankang. In the next step, direct settlement among cities will also be realized based on demand.

Relevant personnel from the Provincial Department of Human Resources and Social Security said that in terms of direct settlement of cross-provincial employees’ medical insurance in different places, employees at the provincial level in our province have already achieved direct settlement in different places in Hainan. Qinghai and Xinjiang can also go to Xi'an for medical treatment in other places. At present, most of the employees in our province working in other places are in Beijing and Shanghai. However, these two are megacities and require coordination by the state to achieve direct settlement in other places, which also requires a process. In accordance with the goals set by the three national ministries and commissions, in 2015, the direct settlement of hospitalization expenses in other places within the province will be basically realized, and a national-level settlement platform for out-of-town medical treatment will be established; in 2016, the direct settlement of hospitalization medical expenses for retirees resettled in other places across provinces will be fully realized. The Provincial Department of Human Resources and Social Security requires that all localities should ensure that the target tasks of direct settlement of hospitalization expenses in other places are completed on time and with high quality on the basis of the existing direct settlement of medical treatment within the municipal coordination area and the settlement of medical treatment in other places across the coordination areas. In the implementation, it is necessary to follow the hierarchical promotion idea of ??improving municipal-level coordination, standardizing the settlement of medical treatment in different places within the province, and promoting the settlement of medical treatment in different places across provinces, correctly guiding the people to seek reasonable medical treatment, and preventing the over-emphasis on the convenience of medical treatment and settlement from aggravating the situation of medical patients. Excessive concentration in big cities and large hospitals will increase medical insurance funds and the burden on the people. At the same time, grasp the special policies for relocating retirees in other places. When retirees are relocated to other places to seek medical treatment in other places across provinces, the medical insurance payment scope, payment ratio, payment limit and personal account fund use and other policies should be reasonably determined based on the actual situation in accordance with the requirements of national documents. Prefectures and cities that have the conditions should actively explore the use of social security cards and transfer personal account funds to the bank accounts of social security cards to facilitate the use of insured persons. For retirees who voluntarily choose direct settlement in other places, the social security agency in the place of residence will register and record them and bring them into unified management. For people referred from other places, it is necessary to adapt to the hierarchical diagnosis and treatment model and the referral system, establish a collaboration mechanism between the social security agencies in the insured place and the place of treatment, and guide the formation of a reasonable medical order. For temporary out-of-town emergency patients, if the insured place deems it necessary to verify the authenticity of the expenses, the social security agency in the place of medical treatment should provide assistance. Medical insurance agencies at all levels should gradually introduce the concept of "medical treatment place management", and the social security agency at the place of medical treatment will provide insured persons with services in cost settlement, medical treatment management, and medical behavior monitoring.