Reimbursement ratio
The reimbursement of hospitalization expenses for urban workers' basic medical insurance in different places outside the region was adjusted from 150 yuan, 350 yuan and 1000 yuan to 300 yuan, 500 yuan and 1200 yuan respectively; The reimbursement rate of medical expenses within the scope of medical insurance policy was adjusted from 93%, 90% and 88% to 95%, 90% and 80% respectively; Adjust the annual maximum payment limit of basic medical insurance from 60,000 yuan to 50,000 yuan, and the medical expenses exceeding the annual maximum payment limit will be reimbursed by large Medicaid, and the maximum payment amount of large Medicaid will be adjusted from 240,000 yuan to no cap; 90% of the medical expenses with the reimbursement amount of large Medicaid less than 350,000 yuan, and 70% of the medical expenses with the reimbursement amount of more than 350,000 yuan. The deductible line of basic medical insurance for urban and rural residents in different places outside the district is level 3 and level 3 medical institutions 1000 yuan; The proportion of reimbursement for primary, secondary and tertiary medical expenses in the original medical insurance policy of tertiary medical institutions was adjusted from 70%, 80% and 85% to 45%, 60% and 65% respectively.
Other related matters.
In the future, employees and urban and rural residents who participate in medical insurance will no longer be divided into three categories: top three and top three, and all of them will implement the relevant policies of top three. The hospitalization bed fee for basic medical insurance shall be paid by 15 yuan/day. Drugs entering the scope of medical insurance policy are no longer classified into categories A and B, and medical consumables for employees' medical insurance are no longer paid in installments. Medical expenses are included in the scope of medical insurance policy and paid according to the proportion stipulated by the hospital level. Insured personnel should strictly perform the examination and approval procedures for referral or residence in different places, and meet the requirements for immediate settlement of medical treatment in different places. In addition, Ningxia 2065438+June 2006 began to implement serious illness and tumor insurance for urban and rural residents. If the insured suffers from high hospitalization medical expenses due to serious cancer, when reimbursing the basic medical expenses, the patient pays more than 6,000 yuan in compliance medical expenses, and the urban and rural residents' serious cancer insurance will intervene. This policy has been piloted in Guyuan City and Shizuishan City in accordance with the municipal overall planning model, and will be gradually promoted throughout the region this year.
Bao Ge Tip: What is the reimbursement ratio of Guyuan medical insurance? It is not difficult to know from the above that if the insured person in Guyuan City is hospitalized in a different place, the reimbursement rate of medical expenses within the scope of reimbursement can reach up to 95%, and the reimbursement rate of large medical expenses can reach up to 90%. In addition, the reimbursement standards for hospitalization expenses of residents and employees in different places have all been adjusted to the implementation standards of top three hospitals.