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What is the reimbursement ratio of medical insurance for urban and rural residents in 2019? What's t

Medical insurance is very important for each of us. It is not only related to personal health, but also related to every family. The medical reimbursement system can alleviate the difficulty of seeing a doctor to a certain extent. What is the reimbursement ratio of social security in 2019?

China's medical insurance is mainly divided into employee medical insurance and urban and rural residents' medical insurance. Employee medical insurance is the medical insurance in the social security paid by office workers, while urban and rural residents' medical insurance is paid by individuals, such as the elderly, students, individuals and the new rural cooperative medical system. These two kinds of medical insurance have different payment methods, payment proportion and payment base, so the reimbursement proportion is different Different.

1. Medical insurance for employees. The proportion of hospitalization reimbursement of employee medical insurance is divided according to the actual hospitalization expenses of the insured. The reimbursement rate was 85% for inpatient expenses between 1300 yuan and 30000 yuan, 90% for inpatient expenses between 30000 yuan and 40000 yuan, 95% for inpatient expenses between 40000 yuan and 100000 yuan, and 85% for inpatient expenses between 100000 yuan and 300000 yuan.

In addition, the proportion of reimbursement is 90% for medical expenses incurred in community outpatient service, and 70% for medical expenses incurred in non community outpatient service.

2. Medical insurance for urban and rural residents. The reimbursement proportion of medical insurance for urban and rural residents is divided according to the level of hospitals

1) The reimbursement rate of the first-class hospital is 65%, and the threshold of the starting line is 300 yuan;

2) The reimbursement proportion of secondary hospitals varies according to the amount of medical expenses. The reimbursement proportion of medical expenses within 6000 yuan is 65%, the reimbursement proportion of medical expenses over 6000 yuan is 80%, and the threshold of the starting line is 400 yuan. If the reimbursement is made in municipal secondary hospitals, the starting line will be slightly higher, generally 600 yuan;

3) Third level hospitals: the reimbursement proportion and the minimum payment line of county level hospitals and city level hospitals are different. The reimbursement proportion of county level hospitals whose medical expenses are less than 6000 yuan is 65%, the reimbursement proportion of hospitals whose medical expenses are more than 6000 yuan is 80%, and the threshold of minimum payment line is 600 yuan; The reimbursement proportion of medical expenses in municipal tertiary hospitals is 55% when the medical expenses are less than 12000 yuan, 75% when the medical expenses are more than 12000 yuan, and the threshold of starting payment line is 800 yuan.

As for the proportion of medical insurance, the state does not have a specific unified standard. Different regions have different economic levels. Therefore, in terms of medical reimbursement, the proportion of reimbursement is also different. Therefore, the specific reimbursement proportion is subject to the local regulations.

The reimbursement of rural cooperative medical system is mainly divided into three categories, which are serious illness reimbursement, hospitalization reimbursement and outpatient reimbursement. Reimbursement scope for serious illness: the medical expenses for serious illness in accordance with the provisions shall be subject to the basic medical insurance and medical service items of basic medical insurance in each province.

Scope of hospitalization reimbursement: Hospitalization Reimbursement includes drug reimbursement and treatment expense reimbursement. Drug reimbursement needs to refer to the drug reimbursement catalogue of the province. During hospitalization, treatment expense, drug expense, laboratory expense, inspection expense, operation expense and hospitalization expense are reimbursable medical expenses. Outpatient reimbursement scope: Outpatient reimbursement includes drug reimbursement and inspection expense reimbursement, and the drug reimbursement is the prescribed drug; inspection expense includes B-ultrasound, ECG, test fee, treatment fee, infusion fee, etc.

1. According to hospital level

For the designated hospitals in villages and towns, 85% of the farmers spend more than 100 yuan, 75% of the county hospitals spend more than 400 yuan, and 65% of the municipal hospitals spend more than 1000 yuan.

2. According to the type of medical treatment

Outpatient reimbursement: 60% in village clinics and village center clinics, 40% in township hospitals, 30% in secondary hospitals and 20% in tertiary hospitals. Hospitalization reimbursement: 60% for township hospitals, 40% for secondary hospitals and 30% for tertiary hospitals.

Reimbursement for serious illness: for inpatients who participate in cooperative medical system, the one-time or annual accumulative medical expenses should be compensated by more than 5000 yuan, that is, 65% of 5001-10000 yuan and 70% of 10001-18000 yuan. In addition, as long as it is in the township level cooperative medical care hospital and uremic outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy, it can also limit compensation of 11000 yuan per year.