Reimbursement ratio:
First, under normal circumstances, when you need to be hospitalized due to illness, you can go to the designated hospital with the medical insurance card and medical records, and you can use the medical insurance card for settlement. That is, some of them are paid by themselves, and some medical insurance centers and hospitals reimburse and settle accounts;
Second, if you transfer from a designated hospital to a secondary or tertiary hospital, the medical insurance card will be settled, as above;
Three, critically ill, in the designated hospital emergency treatment, within 5 days to the city medical insurance center for emergency rescue disease identification, identified as emergency rescue disease, you can use the medical insurance card in the rescue hospital settlement;
Four, transferred to other places for treatment, with the consent of the hospital and medical insurance center, for referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement;
Five, do special provisions of the disease (cancer, uremia, organ transplantation) that, in hospital, the same as above with medical insurance card settlement. The medical insurance card is still used when taking medicine out of the clinic, and the bills settled by individuals at their own expense are reimbursed by the community labor security workstation this year;
Six, there is a special situation, that is, the need for cataract phacoemulsification and intraocular lens implantation, choose a capable hospital (not necessarily a hospital designated by yourself). No hospitalization, direct outpatient surgery, still using the medical insurance card, first settled at their own expense, and reimbursed by the community labor security workstation after diagnosis and treatment.
Description of reimbursement:
1, the use of special medical materials or disposable medical materials with a unit price of more than 1000 yuan, and the installation and replacement of artificial organs shall be paid by the basic medical insurance pooling fund at 90% of the domestic general price;
2, chronic renal failure outpatient dialysis, organ transplantation outpatient anti-rejection drug therapy, malignant tumor outpatient chemotherapy, radiotherapy, interventional therapy or radionuclide therapy of basic medical expenses, by the basic medical insurance fund to pay 90%.
3, outpatient special examination and treatment costs by the basic medical insurance fund to pay 80%, the individual pays 20%;
4. Continuous payment is linked to the reimbursement ratio. After two years of continuous insurance, the reimbursement rate increased to 765,438+0%, and after four years of continuous insurance, the reimbursement rate increased to 72%, and so on.