Ji'nan will not reimburse residents from medical insurance reimbursement next month.
Shun Net - Ji'nan times
, Ji'nan municipal government portal published "some policies on the adjustment of residents' basic medical insurance" The notice ", the resident medical insurance participants (excluding the insured college students) in the fund of the fund in the range of hospitalization or outpatient medical expenses, no longer distinguish between individual payment grade.
from January 1, 2015, the medical insurance system of Ji'nan urban residents and the new rural cooperative medical insurance system have been integrated fully, and the payment standards are unified into three grades: one is that 80 yuan and two of students' children's children's files are 300 yuan for adult residents, equivalent to adult residents who have participated in medical insurance of urban residents three are adult residents. The second gear is 100 yuan, which is equivalent to the standard of the adult residents who participate in the original NCMS.
pay scale is different, reimbursement ratio is also different. In the case of hospitalization in the two level medical institution, the proportion of inpatient reimbursement for young and young children and adult residents according to the standard of one file is 65% for the basic medical insurance fund for residents and 35% for the personal burden. The reimbursement rate of adult residents according to the second standard is 60%: the basic medical insurance fund is paid by the residents, and the personal burden is 40%.
starting in April 1st this year, the medical expenses of the hospitalized or outpatient department of the insured person (excluding the insured college students) in the hospital or outpatient service will not be distinguished from the personal payment grade. That is to say, in the two level medical institutions, the proportion of fund payment is 65% in the first level medical institutions, the proportion of fund payment is 75% in the medical institutions which fully implement the national basic drug system, and the proportion of fund payment is 90%. In the three level medical institutions, as well as out of the outpatient provisions of the disease of renal failure dialysis treatment, the fund payment ratio is still in accordance with the current provisions of the implementation, this time no adjustment.
this part of the policy adjustment also includes: the inclusion of basic medical insurance category a catalogue drugs into the general out-patient overall payment range, the brain CT and other diagnosis and treatment projects, as well as the therapeutic massage and other Chinese medical treatment projects in 72 items into the general out-patient overall payment scope.
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assuming insured person Xiao Ming was insured in accordance with the standard of payment for the second grade of adult residents, he spent 20 thousand yuan in the two level medical institution, removed the cost of the starting line of 700 yuan, the remaining 19 thousand and 300 yuan assumed all compliance, and was paid by the fund by proportion, the original reimbursement ratio was 60%, from April 1st this year, he was compared to the original It can reimburse 5% more and save 965 yuan.