The reimbursement ratio of urban and rural medical insurance in Chongqing is divided according to different medical items and expense types, aiming at reducing the medical burden of urban and rural residents. The specific reimbursement rate includes outpatient service, hospitalization and serious illness, which will be explained in detail below.
First of all, outpatient reimbursement is a common type of reimbursement in the medical insurance system. In Chongqing, the medical insurance for urban and rural residents has certain proportional restrictions on the reimbursement of outpatient medical expenses. Generally speaking, medical insurance can reimburse a part of the outpatient expenses that meet the requirements, but the specific proportion will vary according to different medical projects. At the same time, outpatient reimbursement usually has a deductible line and a capping line, and the part that exceeds these limits may not be reimbursed.
Secondly, hospitalization reimbursement is an important part of the medical insurance system. Medical expenses incurred by urban and rural residents due to illness or accidental hospitalization shall be reimbursed by medical insurance according to a certain proportion. Hospitalization reimbursement usually includes bed fee, nursing fee, operation fee, medicine fee, etc. In Chongqing, the specific reimbursement ratio will be determined according to the level of medical institutions, the type of hospitalization expenses and individual contributions.
In addition, reimbursement for serious illness is a special reimbursement method for high medical expenses in the medical insurance system. Medical insurance will provide additional reimbursement support for the high medical expenses incurred by urban and rural residents due to serious illness. In Chongqing, the specific policies for reimbursement of serious illness include the provisions on reimbursement ratio, minimum payment standard and reimbursement scope, aiming at ensuring that seriously ill patients can get timely and effective medical assistance.
To sum up:
The proportion of urban and rural medical insurance reimbursement in Chongqing is divided according to different medical items and expense types such as outpatient service, hospitalization and serious illness, and the specific proportion will be determined according to different medical items, the level of medical institutions, individual contributions and other factors. At the same time, the medical insurance system also has restrictions such as deductible line and capping line, and the part beyond these restrictions may not be reimbursed.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 26 provides that:
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Measures for the implementation of basic medical insurance for urban and rural residents in Chongqing
Article 14 stipulates:
The hospitalization expenses incurred by insured residents in designated medical institutions in accordance with the provisions of these measures shall be settled by time. At each settlement, after deducting the minimum payment standard, the expenses that meet the scope of reimbursement will be paid in proportion.
Measures for the implementation of serious illness insurance for urban and rural residents in Chongqing
Article 5 provides that:
The serious illness insurance fund is allocated from the urban and rural residents' medical insurance fund to pay for the compliance medical expenses incurred by the insured residents and reimbursed by the basic medical insurance.