1, students, children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no qifubiaozhun for first-class hospitals, and the reimbursement rate is 65%;
2. Older people over 70 years old. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no qifubiaozhun for first-class hospitals, and the reimbursement rate is 65%;
3. Other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.
The basic insurance does not pay the cost of diagnosis and treatment project scope:
1, service item class
(1) Registration fee, out-of-hospital consultation fee, medical record fee, etc.
(2) Special medical services, such as visiting fees, expedited fees for examination and treatment, additional fees for roll-call surgery, high-quality and good-price fees, and self-invited special care fees.
2. Non-disease treatment projects
(1) All kinds of beauty (life beauty, medical beauty) bodybuilding projects, as well as disorderly non-functional plastic surgery and orthopedic surgery.
(2) various weight loss, weight gain and height increase projects;
(3) various health checks;
(4) all kinds of preventive health care and diagnosis projects;
(5) Orthodontics and porcelain;
(6) all kinds of medical consultation (excluding psychiatric consultation) and medical appraisal.