1, the reimbursement rate of township hospitals above the deductible line is 90%;
2. The reimbursement rate of deductible line in hospitals above the county level is 85%;
3, the city's second-class hospitals deductible reimbursement rate is 80%;
4. The reimbursement rate of the first-level and third-level hospitals in the city above the deductible line is 75%.
The scope of hospitalization reimbursement of medical insurance is as follows:
1, medical expenses, auxiliary examinations: operation expenses for electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic resonance and other examinations;
2. The elderly over 60 years old are hospitalized in the town health center, and the treatment fee and nursing fee are compensated every day.
The medical insurance reimbursement process is as follows:
1. When the applicant submits the application materials, the accepting department shall review the application materials within 5 days from the date of receiving the application materials and decide whether to accept them;
2. If the application materials are incomplete, inform the applicant of all the contents that need to be corrected at one time within the above 5 days;
3. The applicant shall make corrections within 5 days from the date of receiving the notice of correction of materials;
4, overdue correction, as the withdrawal of the application;
5. However, after the materials are corrected, the applicant may reapply within the statutory validity period;
6. After the Social Insurance Fund Administration has reviewed the materials and approved the application, the applicant will receive the reimbursement form for medical expenses of social medical insurance and be reimbursed.
Medical insurance hospitalization reimbursement materials are as follows:
The materials required for medical insurance reimbursement are as follows:
1, copy of ID card and medical insurance card;
2. A copy of the savings card or passbook of China Bank;
3, invoices (medical settlement documents reimbursement vouchers), medical expenses detailed summary list;
4. Copy of hospitalization medical records (including: medical record home page, admission records, long-term doctor's orders, temporary doctor's orders, discharge records or discharge summaries, main inspection results and operation records);
5. Discharge certificate;
6. When the accidental injury is reimbursed in hospital, it is necessary to provide the injury process certificate issued by the public security organ or neighborhood committee of the injured place.
To sum up, in a settlement year, the reimbursement rate of township hospitals is 90%, county hospitals are 85%, municipal hospitals are 80%, and municipal hospitals are 75%.
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.