In addition, the reimbursement rate of students and children in tertiary hospitals (below 6.5438+0.8 million yuan) is 55%; The reimbursement rate of secondary hospitals is 60%; The reimbursement rate of first-class hospitals is 65%.
For the elderly over 70 years old (below 6,543,800 yuan), the reimbursement rate of tertiary hospitals is 50%; The reimbursement rate for hospitalization is 60%; The reimbursement rate of first-class hospitals is 65%. Finally, the reimbursement rate of other urban residents (below 6,543,800 yuan) is 50% in tertiary hospitals and 55% in secondary hospitals; The reimbursement rate of first-class hospitals is 60%.
Then, the reimbursement rate of basic drug medical insurance is: the reimbursement rate of basic drugs in first-class hospitals is 20%, and the reimbursement rate of non-implementation of basic drugs is 40%. The reimbursement of essential drugs in secondary hospitals is 42% and that in tertiary hospitals is 55%.
In hospitalization reimbursement, the longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of the medical insurance fund will increase by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative amount will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively. However, the proportion of reimbursement for medical treatment in non-insured places is paid twice, and hospitalization in designated medical institutions at or below the second level in non-insured places does not require referral approval, and reimbursement is directly settled in the hospital where the medical treatment is conducted according to the prescribed proportion. The first-level payment can be reimbursed in proportion in hospitals outside the city with the proof of referral, and 10% of medical expenses must be paid in advance if the referral is not approved. Proportion of reimbursement for medical treatment in different places: the second kind of payment, with the referral certificate to the designated hospital in the province, directly reimbursed in the hospital after discharge, enjoying the reimbursement policy for hospitalization in the province, and individuals do not need to advance hospitalization expenses. In addition, if there is a second reimbursement, the part within the scope of payment of the urban residents' basic medical insurance co-ordination fund, after the basic medical insurance co-ordination fund pays in proportion, the part of the personal burden exceeding 8,000 yuan will be given a "second reimbursement" by the serious illness insurance fund according to the proportion of 55%.
After the basic medical insurance payment and "second reimbursement", the annual accumulated hospitalization medical expenses of the insured residents (including the compliant and reasonable self-funded part) exceed 25,000 yuan, and the excess part is "reimbursed" again by the serious illness insurance fund according to the proportion of 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan.