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.
Legal basis: Article 3 of People's Republic of China (PRC) Social Insurance Law.
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.