1, outpatient reimbursement There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. In a medical insurance year, there is no deductible for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed at the rate of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan;

2. The proportion of hospitalization reimbursement The longer the continuous insurance period, the greater the proportion of reimbursement. The proportion of hospitalization reimbursement of the medical insurance fund will increase by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative amount will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

The process of medical reimbursement is as follows:

1, medical insurance, whether for urban workers or urban residents, must be hospitalized in accordance with the local designated medical institutions approved by the local medical insurance institutions;

2. If you need to go to other medical institutions for treatment, you need to issue a referral certificate to the local community hospital or community health service center or designated medical institutions;

3. If you are hospitalized in a local medical insurance designated medical institution, the hospital will automatically deduct the medical insurance reimbursement when you check out;

4. In the local medical insurance designated places for treatment but not hospitalization, or receiving radiotherapy and chemotherapy treatment, but not reimbursed in the hospital, you can bring the relevant information issued by the hospital to the medical insurance window of the local administrative service center for reimbursement. Details are as follows:

(1) official invoice;

(2) medical diagnosis;

(3) A detailed list of drugs;

(4) Social security card or medical card.

5. If you have been treated in other medical institutions and have a referral certificate, you must reimburse all treatment invoices, hospital diagnosis certificates, hospitalization certificates, ID cards, social security cards, medication lists and medical records before 65438+February 3/0/every year after discharge.

To sum up, the thresholds of "residents" are 1000, 500 and 300 yuan respectively, and the proportion of fund payment is 65%, 85% and 90% respectively; The minimum threshold for "students and children" in tertiary, secondary and primary hospitals is 500, 400 and 300 yuan respectively, and the proportion of fund payment is 80%, 90% and 95% respectively.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.