Proportion and scope of reimbursement

The medical expenses paid by the basic medical insurance fund must meet the requirements.

1, basic medical insurance coverage

2, the basic medical insurance diagnosis and treatment project scope

3, the basic medical insurance medical service facilities standard range

4, outpatient special diseases and diagnosis and treatment project directory scope has corresponding management regulations.

Proportion of reimbursement for urban residents and college students:

First, the general outpatient compensation treatment

Reimbursement ratio: 50%

Annual maximum payment limit (400 yuan/person calculated according to actual reimbursement amount)

Note: The maximum annual payment limit for college students (including minimum payment standard and proportional out-of-pocket expenses): 2,000 yuan/person.

Second, the special disease outpatient compensation treatment

The reimbursement rate for outpatient service for special diseases is 60%.

Outpatient expenses for serious diseases and special diseases (within 60,000 yuan (including 60,000 yuan): 70%; More than 60,000 yuan to 6.5438+0.4 million yuan (including 40% of the reimbursement ratio of 6.5438+0.4 million yuan)

Third, hospitalization compensation treatment

The expenses in basic medical insurance coverage are ≤ 60,000 yuan (the reimbursement ratio is 55%-90%).

60 thousand yuan