Now whether you live in a big city or in a rural area, you will know something about health care and have purchased it. For many sick people, is it possible to relieve the pressure a little? What is the new policy of medical insurance reimbursement in 2019? What is the standard of reimbursement proportion? How to make reimbursement? The specific analysis is as follows:
1、 What is the reimbursement ratio standard for the new policy of medical insurance reimbursement in 2019?
We all know that the economic level of different places is different, and there will be some differences in medical insurance reimbursement. Therefore, the general reimbursement proportion standards are as follows for reference only. The specific reimbursement proportion standards are based on the documents issued by the local government and the actual reimbursement situation.
1. New policy of medical insurance reimbursement in 2019: what is the proportion standard of outpatient reimbursement?
(1) If you see a doctor in the local village center health room, the reimbursement rate standard is 60%, and it belongs to the scope of medical insurance, the drug fee for each visit is limited to 10 yuan, and the drug fee for the temporary rehydration prescription of the doctor in the health center is limited to 50 yuan.
(2) If you see a doctor in the local town health center, the reimbursement rate is 40%, the limit of each examination fee and operation fee required for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan; that is to say, if the medical fee you prescribe is between 200-500 yuan, you can only claim 100 yuan.
(3) If you see a doctor in the local secondary hospital, the reimbursement rate is 30%, the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.
(4) If you see a doctor in a local tertiary hospital, the reimbursement rate standard is 20%, the limit of each examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 200 yuan.
2. New policy of medical insurance reimbursement in 2019: what is the proportion standard of hospitalization reimbursement?
(1) The reimbursement proportion standard of auxiliary examination drug expenses: the reimbursement limit of examination expenses such as cardio EEG, X-ray fluoroscopy, radiography, laboratory test, physical therapy, acupuncture, CT, MRI is 200 yuan; that is to say, if 400 yuan is needed for photography, only 200 yuan can be reimbursed at the time of final reimbursement.
(2) Standard of reimbursement proportion of operation expenses: according to the national standard, those over 1000 yuan will be reimbursed as 1000 yuan; the elderly over 60 years old will be hospitalized in the hospital, and the treatment and nursing expenses will be compensated as 10 yuan per day, with a limit of 200 yuan.
(3) The reimbursement proportion standard of inpatient hospitals at all levels: the reimbursement proportion of township hospitals is 60%; the reimbursement proportion of secondary hospitals is 40%; the reimbursement proportion of tertiary hospitals is 30%.
3. New policy of medical insurance reimbursement in 2019: what is the standard of reimbursement proportion for serious illness?
(1) If you participate in the local medical insurance payment, the proportion of reimbursement for serious illness will be compensated in one-off or annual medical expenses more than 5000 yuan. If the medical expenses are between 5001 and 10000 yuan, the compensation standard is 65%. If the medical expenses are between 10001 and 18000 yuan, the compensation standard is 70%.
(2) If you participate in the medical insurance payment in the local area, the reimbursement proportion for serious illness will be compensated in one time or in sections with annual medical expenses over 5000 yuan. If the medical expenses are between 5001-10000 yuan, the compensation standard is 65%. If the medical expenses are between 10001-18000 yuan, the compensation standard is 70%.
(3) If you participate in the payment of medical insurance in the local area, the reimbursement rate of one-year reimbursement for inpatient and uremic outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy compensation of town level cooperative medical treatment is limited to 11000 yuan.
The above is the relevant standards on the proportion of medical insurance reimbursement, which is subject to the actual situation of local reimbursement.
2、 How is medical insurance reimbursed?
Now the medical insurance reimbursement can go to the hospital or outpatient clinic directly with the social insurance card, and settle in real time, without the reimbursement process. The settled expense is the expense after reimbursement.
1. If you have money on your medical insurance card, and you can cure the disease in the general outpatient service, you can pay directly by swiping the money on your card. Outpatient treatment (except for special diseases) cannot be reimbursed.
2. If you are in hospital, according to the level and type of hospital expenses you choose, you can accept the expenses of basic medical reimbursement. If you deduct the starting standard, the amount at your own expense, the proportion of self payment and the age proportion, you must be a designated medical institution and settle directly with the hospital.
3. According to the regulations of each region, the reimbursement proportion can cover the expenses of basic medical reimbursement, deduct the starting standard, self expense amount, proportion self payment, age proportion, and if the hospital level provides reimbursement, consult the local social security department for details.