Qifubiaozhun for hospitalization: First-class, second-class and third-class hospitals are unified as 500 yuan. If you are hospitalized for more than 2 times in a year, there will be no deductible from the second hospitalization.
The highest compensation standard: 6.5438+0.8 million yuan.
Outpatient (emergency) consultation reimbursement ratio: 50%
Qifubiaozhun: 500
Maximum payment standard: 4000
Extended data:
The medical insurance reimbursement method for hospitalization expenses is:
1. If you are hospitalized in a designated social security medical institution in the insured place, you can directly use medical insurance to reimburse and settle the payment. However, due to different regulations on the proportion of medical insurance reimbursement in different places, the specific amount of reimbursement depends on local regulations;
2. If you are hospitalized in different places, you need to apply for medical records in different places in advance, and you can record them in the "medical records in different places" applet or the medical insurance service center of the insured place. If you are hospitalized in a different place due to unexpected events, you need to call the hotline of the medical insurance service center in the insured place first, and then file the record after the other party agrees. After successful filing, hospitalization expenses incurred in designated social security medical institutions can be directly reimbursed and settled in the hospital. If you can't make reimbursement in the hospital, you can keep relevant information (such as hospitalization summary, medical expenses list, etc.) and go to the medical insurance service center for reimbursement after returning to the insured place.
Proportion of medical insurance reimbursement
Medical expenses = medical insurance reimbursement expenses+self-paid expenses
Medical insurance reimbursement expenses = (all expenses of Class A drugs+expenses of Class B drugs deducted from the self-paid part+other expenses that meet the requirements of medical insurance)-deductible line × reimbursement ratio.
The most important thing in expense calculation is the reimbursement ratio, which is a little more complicated:
1, the same level of designated medical institutions, the same reimbursement ratio;
2. The identity of the insured will affect the reimbursement ratio. Generally speaking, the reimbursement rate of retired employees' medical insurance participants is higher than that of active employees' medical insurance participants.
3. The level of medical institutions will affect the reimbursement ratio. The reimbursement rate of low-level medical institutions is higher than that of high-level medical institutions;
4. It is particularly important that local regulations are different. It is best to consult the local medical insurance department.