The "Enjoy Health" critical illness insurance plan covers cancer in situ and 60 critical illnesses. The coverage of medical insurance for urban residents is wide and miscellaneous, which provides basic social security for those who cannot be included in the coverage of urban workers. Since the pilot in 2007, the coverage has gradually expanded, and so far, it has basically covered all urban non-employed residents. So what is the reimbursement rate of urban residents participating in medical insurance?
First, the proportion of medical insurance reimbursement for urban residents such as students and 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 in first-class hospitals, and the reimbursement rate is 65%. What kind of critical illness insurance are there for children? Which are cost-effective? Which is the most worth buying? Let's take a look at 10 the inventory of children's critical illness insurance sold by major insurance companies.
The second is the proportion of medical insurance reimbursement for urban residents such as middle-aged and elderly people over 70. 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 in first-class hospitals, and the reimbursement rate is 65%.
The third is the proportion of medical insurance reimbursement for 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%.
According to the relevant person in charge of the Medical Insurance Department of Changsha Labor and Social Security Bureau, if they are on-the-job employees, they can only reimburse more than 2,000 yuan for medical expenses after going to the hospital for emergency treatment, and the proportion of medical insurance reimbursement for urban residents in Changsha is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: how to use social security medical insurance? 1. Teach you how to apply for reimbursement!
No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.
In case of hospitalization expenses, employees and retirees should pay the minimum amount 1300 yuan when using the basic medical insurance for the first time in a year. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.
The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.
Almost everyone who goes to the hospital will encounter this situation. When registering and prescribing drugs, medical staff always ask patients whether they are insured or free of charge or at their own expense. Is it necessary to "look at people and eat vegetables" to see a doctor and take medicine? An ophthalmologist in a hospital who asked not to be named told reporters that generally speaking, the main reason for asking this question is that medical insurance participants can only be reimbursed if they consume drugs in the medical insurance catalogue. In the case of similar curative effect, try to choose drugs that can reimburse the insured. For out-of-pocket patients, there are more choices.
According to the relevant provisions of the "Trial Measures for Basic Medical Insurance for Urban Residents in Changsha", residents who participated in medical insurance for urban residents before April 30 this year have no waiting period for hospitalization, that is, they are insured in the current month and enjoy treatment in the next month. Residents who are insured after May 1 (including that day) have to wait for 3 months to enjoy insurance benefits. However, there is no waiting period for children (born within 6 months) to be insured and hospitalized, that is, they will pay the fee in the current month and enjoy the treatment in the next month.
"At present, we have launched a pilot project of" one-stop settlement of residents' insurance contributions "in communities such as Jiucaiyuan and Jingwanzi." According to the relevant person in charge, at present, China UnionPay credit card terminal system has been installed in pilot communities, and credit card terminal equipment is located in communities and streets, so that insured residents can realize insurance payment in communities and streets.
The medical insurance department is considering perfecting and adjusting the medical insurance policy and adjusting the proportion of medical insurance reimbursement for urban residents in Changsha, so that the insured residents can enjoy more benefits. Specific measures will be implemented after being approved by the municipal government: First, it is planned to increase the proportion of medical insurance reimbursement to more than 50%; The second is to establish a subsidy mechanism for basic medical insurance for urban residents and provide medical assistance to residents with real economic difficulties; The third is to introduce measures for the management of family sickbeds for urban residents' basic medical insurance. When the insured seeks medical treatment, he can save medical expenses by setting up family beds or providing on-site medical services. The fourth is to explore the settlement methods of medical expenses for different groups of people, such as introducing different settlement methods according to the characteristics of children's disease expenses.
Changsha will increase the proportion of medical insurance reimbursement for urban residents in Changsha, and the specific details are currently being revised. Relevant personnel introduced that at the same time, Changsha will further promote the construction industry, entertainment, catering and other service industries to participate in work-related injury insurance, and strive to include all migrant workers who have not participated in medical insurance and work-related injury insurance into the scope of medical insurance and work-related injury insurance for urban employees.
The "Le Kang Worry-Free" refundable hospitalization medical insurance scheme has dual functions of insurance protection and premium refund.