Ji'nan residents medical insurance new deal: three times only pay standard and reimbursement ratio is different.
source:
Volkswagen Ji'nan September 29th news (reporter Sun Chengyun) public network reporter from Ji'nan Social Security Bureau learned that the implementation of the Ji'nan city residents' medical insurance (hereinafter referred to as "the medical insurance new deal") from January 1st next year, although three payments have been set up. Fees, but the maximum annual reimbursement limit for "hospitalization" and "door regulations" is 200 thousand yuan, which is only a difference in reimbursement ratio.
public network reporter learned that the medical insurance new deal stipulates that the insured person in a medical year is in accordance with the residents' basic medical insurance fund payment scope stipulated in the hospital and outpatient medical expenses (including the individual according to a certain proportion of the burden) to carry out the starting and payment standards and the maximum payment limit. The medical expenses above and below the maximum payment limit shall be borne by the individual.
in terms of hospitalization standards, the starting and payment standards for "students and children" are: 700 yuan for grade three medical institutions, 400 yuan for level two medical institutions, and 200 yuan for first level medical institutions (including community health service institutions, the same below), and township health centers, and the starting and payment standards of "adult residents one" and "second grade adult residents" are: Provincial (Department) three level medical institutions 1200 yuan, three other medical institutions 1000 yuan, two medical institutions 700 yuan, first class medical institutions, township hospitals 400 yuan. In a medical year, the standard of the second hospitalization was reduced by 20%, and the starting standard was no longer implemented from the third hospitalization. The three standard of the gate code is 200 yuan. And in a medical year, the insured person only needs to pay a starting payment. There are 8 specified diseases in the outpatient clinic, including the treatment of malignant tumor and leukemia, dialysis therapy for renal failure, anti rejection treatment for organ transplantation, hemophilia, aplastic anemia, systemic lupus erythematosus, Parkinson's disease and syndrome, and psychosis.
in the proportion of reimbursement, "children's children" will be divided into college students (all day general colleges and universities for all kinds of colleges and universities, the full-time undergraduate and specialist students receiving general higher education, full-time graduate students, full-time graduate students) and young children (primary and secondary school students, kindergartens in kindergartens) Children and other residents under the age of 18 who have household registration in this city) are two types.
College Students' hospitalization reimbursement ratio is: in the three level medical institution medical treatment, the resident basic medical insurance fund is paid 60%, the individual burden 40%; in the two level medical institution medical treatment, the resident basic medical insurance fund pays 70%, individual burden 30%; in the first level medical institution, township health hospital medical treatment, by The residents' basic medical insurance fund pays 80% and the personal burden is 20%.
children's inpatient reimbursement is the same as "one city resident". In the provincial (Department) level three medical institutions medical treatment, the residents' basic medical insurance fund is paid 40%, the individual burden is 60%; in other three level medical institutions, the residents' basic medical insurance fund is paid 55%, the individual burden is 45%; at two level Medical institutions of medical institutions will be paid 65% by the basic medical insurance fund for residents and 35% for individuals; 80% for the basic medical insurance fund of the residents and 20% for individual medical insurance funds at the first level medical institutions; 90% for the basic medical insurance fund of the residents and 10% for the personal burden in the township health centers.
"second grade urban residents" in hospital reimbursement ratio is: in the province (Department) three level medical institutions medical, the resident basic medical insurance fund to pay 30%, the personal burden 70%; in other three medical institutions medical, the resident basic medical insurance fund to pay 45%, the personal burden 55%; in the two level medical machine. Medical treatment, the basic medical insurance fund for residents to pay 60%, personal burden of 40%; in the primary medical institutions medical, the residents of basic medical insurance funds to pay 80%, personal burden 20%; in the township health care hospital, the residents basic medical insurance fund to pay 90%, personal burden 10%.