Hospital reimbursement is divided into two parts: basic medical insurance and large amount (residents' medical insurance is called serious illness).

When the hospitalization expenses are reimbursed, the basic medical insurance pooling fund and the large (critical illness) insurance fund are directly settled together.

Basic medical insurance medical insurance hospitalization reimbursement standard

Note: Proportion of hospitalization reimbursement for residents' medical insurance in 2022:

Residents' medical insurance A insured person's hospitalization policy within the scope of the cost is higher than the basic medical insurance Qifubiaozhun to the part below the payment limit, which shall be paid by the overall fund according to the following proportion:

Increase the reimbursement rate of class I insured in tertiary medical institutions to 50% (original 40%); The reimbursement rate of secondary medical institutions has increased to 70% (originally 65%).

The reimbursement rate of second-class insured personnel in secondary medical institutions has increased to 75% (from 72%); The reimbursement rate of tertiary medical institutions has increased to 55% (originally 50%).

The hospitalization of minors rose by 5% on the basis of the overall reimbursement ratio of residents' medical insurance.

Note: the payment limit of basic medical insurance for employees is 47,000 yuan; The payment limit of basic medical insurance for residents is 80,000 yuan in the first file and 1.2 million yuan in the second file.

If the employee is hospitalized for many times within one year, the hospitalization deductible will be reduced by 1 0% on the basis of the above standards for every increase of1time; After the downward adjustment, tertiary hospitals should be no less than 620 yuan/time, secondary hospitals should be no less than 260 yuan/time, and primary hospitals should be no less than 100 yuan/time.

Large reimbursement standard for serious illness insurance for employees and residents

△ 154 12 yuan/person/year is the standard in 2022.

The out-of-pocket expenses in the above table refer to the medical expenses incurred by the insured in the hospitalization and outpatient service of special diseases and major diseases, which are reimbursed by the residents' medical insurance fund first and then paid by the insured.

Tips: College students who participate in residents' medical insurance have different reimbursement standards for hospitalization.

Policy Source: Click to view.