I. Overview of the proportion of medical insurance reimbursement
The proportion of medical insurance reimbursement in Wuhan varies according to the level of medical institutions, the type of medical expenses and the type of individual medical insurance. Generally speaking, the reimbursement rate of primary medical institutions is relatively high, and the reimbursement rate of advanced medical institutions is relatively low. At the same time, there will be different reimbursement rates for different types of medical expenses such as hospitalization expenses, outpatient expenses and medicine expenses.
Two. Specific provisions on reimbursement ratio of medical insurance
According to Wuhan medical insurance policy, the proportion of medical insurance reimbursement in 2024 is roughly as follows:
1. reimbursement of hospitalization expenses: the proportion of reimbursement for medical treatment in primary medical institutions in Wuhan is usually high, which may reach more than 80%; In advanced medical institutions, the reimbursement rate may be slightly lower, generally around 70%.
2. Outpatient expenses reimbursement: The reimbursement ratio of outpatient expenses is usually lower than that of hospitalization expenses, but it will also be different according to the level of medical institutions and the type of medical insurance. Generally speaking, the proportion of outpatient reimbursement in primary medical institutions is between 50% and 60%.
3. Drug reimbursement: Wuhan Medical Insurance will reimburse the drugs included in the medical insurance catalogue according to a certain proportion. The specific reimbursement ratio will be different according to the types of drugs and medical insurance.
It should be noted that the above is only an approximate reimbursement ratio, and the specific reimbursement ratio needs to be determined according to the medical insurance policy and personal medical insurance type of the year.
Three, the factors affecting the proportion of medical insurance reimbursement
In addition to the level of medical institutions and the type of medical expenses, the type of personal medical insurance will also have an impact on the reimbursement ratio. For example, there may be differences in the reimbursement ratio of employee medical insurance and resident medical insurance in Wuhan. In addition, factors such as personal payment and medical treatment behavior may also have an impact on the reimbursement ratio.
To sum up:
Wuhan Medical Insurance Reimbursement Ratio 2024 is a policy of Wuhan to give a certain proportion of medical expenses incurred by insured residents in the process of medical treatment according to the medical insurance policy and individual medical insurance types of that year. The specific reimbursement ratio will vary according to the level of medical institutions, the type of medical expenses and the type of individual medical insurance. In order to obtain more accurate information on reimbursement ratio, it is suggested that insured residents pay attention to the official notice and policy documents of Wuhan medical insurance department.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Measures of Wuhan Municipality on Basic Medical Insurance for Urban Workers
According to the relevant provisions of this method, the medical expenses incurred by employees participating in the basic medical insurance for urban employees in Wuhan during medical treatment shall be reimbursed according to a certain proportion. The specific proportion and scope of reimbursement will be stipulated in accordance with the specific provisions of these measures.