1, outpatient fee. In a natural year, after the general outpatient and emergency expenses exceed 1800 yuan, the proportion of reimbursement for the excess part is 50%; For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%; For retirees over 70 years old,1.Expenses above 300 yuan can be reimbursed, and the reimbursement rate is 80%.
2. hospitalization expenses. Qifubiaozhun varies according to different levels of hospitals, including township hospitals 150 yuan, county-level secondary hospitals or hospitals below a certain scale, 400 yuan, municipal secondary hospitals or hospitals below a certain scale, 500 yuan, and municipal tertiary hospitals 1200 yuan.
3. Reimbursement ratio. The reimbursement ratio of different levels of hospitals is also different. For example, the reimbursement rate of township hospitals is 70% to 90%, that of hospitals at or below the county level is 63% to 83%, that of hospitals at or below the city level is 55% to 75%, and that of municipal hospitals is 53% to 72%.
4. Specific diseases. For some serious diseases such as congenital heart disease in children, the subsidy amount of the new rural cooperative medical system is 70%.
Zhoukou hospitalization expense reimbursement process:
1. The agent submits the reimbursement documents and other materials to the Social Insurance Fund Administration for acceptance.
2. After receiving the application materials, the accepting department shall complete the examination, settlement and payment on the same day.
3, the social insurance fund management bureau to review the materials and approve the application, the applicant to receive the "social medical insurance medical expenses reimbursement form", be reimbursed.
To sum up, the proportion of medical insurance reimbursement in Zhoukou Central Hospital varies with factors such as patients' enrollment type, hospital level, age, etc. Patients should understand the corresponding reimbursement policies and processes according to specific conditions.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.