1, outpatient reimbursement: the reimbursement rate of township hospitals is 80%, and the highest reimbursement ceiling is 1000 yuan; The compensation ratio of county-level hospitals is 70%, and the maximum reimbursement ceiling line is 3000 yuan; The compensation ratio of secondary hospitals in the city is 60%, and the maximum reimbursement ceiling line is 9000 yuan; The compensation ratio of municipal tertiary hospitals is 55%, and the highest reimbursement ceiling line is 13000 yuan;
2. Hospitalization reimbursement: the proportion of hospitalization compensation in township hospitals is 80%, and the highest reimbursement ceiling is 8,000 yuan; The proportion of hospitalization compensation in county-level hospitals is 70%, and the maximum reimbursement limit is 30 thousand yuan; The proportion of hospitalization compensation in secondary hospitals in the city is 60%, and the maximum reimbursement ceiling line is 24,000 yuan; The proportion of hospitalization compensation in tertiary hospitals in the city is 55%, and the maximum reimbursement ceiling line is 26,000 yuan.
Medical insurance reimbursement materials:
1, medical insurance card: hold a valid medical insurance card;
2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.
3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;
4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;
5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;
6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.
To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.
Legal basis:
Article 2 of People's Republic of China (PRC) Social Insurance Law
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
essay
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.