The lowest pay pool
This is the pool share in the past three months:
I hope to adopt it
For the first hospitalization in a medical year, the starting line should be controlled at about 5% - 10% of the average annual salary of local employees in principle. The starting line is closely related to the hospital level and hospitalization times. The higher the hospital level is, the higher the starting line is. The lower the hospital level is, the lower the starting line is. In the same medical year, the starting line decreases with the increase of hospitalization times. Generally speaking, the starting line is no longer charged for the fourth hospitalization in the same medical year
extended data:
the expenses within the starting line are borne by indivials, which are higher than the expenses of the starting line (excluding the part of self funded drugs). After the money of the starting line is removed, the medical insurance will reimbursement according to the specified proportion
The medical expenses below the starting line were paid by the participating farmers themselves. According to the policies of different cities, there may be a minimum payment line for chronic diseases, and there may also be a minimum payment line for general outpatient services of urban residentsThe starting line refers to the starting standard of the medical insurance fund. For the medical expenses actually incurred by the insured in the "three catalogues" of the designated medical institutions, they should first bear the expenses below the starting standard, and the part above the starting standard will be reimbursed by the medical insurance fund according to the regulations and proportion
according to different regions, medical institutions, outpatient or inpatient conditions, the starting line standard varies from several hundred yuan to more than 1000 yuan
the top line refers to the maximum payment limit of the medical insurance fund, that is, the maximum amount of reimbursement that the insured can get from the medical insurance fund in a year. For medical expenses beyond the top line, the insured can take part in supplementary medical insurance and commercial medical insurance
extended data:
definition
"basic medical security" is a concept with Chinese characteristics, which means that the level of medical security must adapt to the level of social and economic development, as the saying goes, it means how much money to do how many things. China's current medical insurance system is not high in the overall level of protection, and there are many restrictions on the payment of the insured
First, the medical expenses below the starting line are borne by the patients or shared by the patients and their units, which enhances the insured's awareness of expenses and helps to rece waste; Secondly, a large number of small medical expenses are excluded from the reimbursement scope of medical insurance, which reces the workload of insurance settlement and helps to rece the management cost; Third, small expenses are borne by the insured, which is concive to the protection of disease risk with high expenses, that is, serious illnessThe starting standard of basic medical insurance for urban residents refers to that the expenses above the starting standard will be reimbursed in proportion, and the expenses below the starting standard will be borne by indivials
1. For the first-class designated medical institutions (including community health service institutions), the overall fund will pay 60%, and the indivial will bear 40%
2. For the second-class designated medical institutions, the overall fund will pay 55%, and the indivial will bear 45%
3. For the third-class designated medical institutions, the overall fund will pay 50%, and the indivial will bear 50%
2 Reimbursement ratio of basic medical insurance for urban residents
1. For students and children
in a settlement year, if the medical expenses below 180000 yuan meet the reimbursement scope, the minimum payment standard for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard in the first level hospital, and the reimbursement proportion is 65%
2. For the elderly over 70 years old, the minimum payment standard in the third level hospital is 500 yuan, and the reimbursement proportion is 50%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard for the first-class hospitals, and the reimbursement proportion is 65%
3. For other urban residents, the minimum payment standard is 500 yuan, and the reimbursement proportion is 50%; The starting standard of hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no minimum payment standard for the first-class hospitals, and the reimbursement ratio is 60%
extended data:
1. Reimbursement scope of basic medical insurance for urban residents
1. Medical expenses for hospitalization treatment
2. Medical expenses within 7 days before emergency observation and transfer to hospitalization treatment
3. Medical expenses in line with the regulations for special diseases in outpatient department of urban residents
2 The basic medical insurance payment amount for urban residents is
1. The annual financing standard for each student and child is 100 yuan, the indivial pays 60 yuan of medical insurance premium, and the remaining 40 yuan is subsidized by the government. For students and children with severe disabilities, those who enjoy the minimum living allowance and those from families with special difficulties, the indivial does not pay, and the medical insurance premium is all subsidized by the government.
2. Non employed urban alt residents raise funds at the rate of 560 yuan per person per year.
3. For those with severe disabilities, those who enjoy the minimum living allowance, those from families with special difficulties and those from low-income families over 60 years old, the indivial does not pay, All medical insurance premiums are subsidized by the government
4. The elderly over 70 years old pay 120 yuan of medical insurance premiums, the rest 440 yuan is subsidized by the government
5. Other non employed urban residents pay 330 yuan of medical insurance premiums, and the rest 230 yuan is subsidized by the government
In fact, there are many kinds of medical insurance in China, among which the most common are employee medical insurance, urban residents medical insurance and so on. For different types of medical insurance, the actual conditions are different, and the scope, conditions and standards of natural reimbursement are also different. And belong to the medical insurance in social insurance system, it is employee medical insurance, namely basic medical insurance
1. Medical insurance for urban employees
annual reimbursement limit of outpatient service: 20000 yuan
starting line: 1800 yuan for in-service staff, and reimbursement ratio: 70%. For retirees, the reimbursement rate is from 85%
annual reimbursement limit of hospitalization: 300000 yuan
2. Medical insurance for urban and rural residents
annual reimbursement limit of outpatient service: 3000 yuan
starting line: from 100 yuan in first-class hospitals, the reimbursement rate was 55%. From 550 yuan, the reimbursement ratio is from 50%
the starting standard of medical insurance is the starting line of "basic medical insurance"
the medical expenses actually incurred by the insured in the designated medical institutions within the scope of the "directory" of basic medical insurance should be borne by themselves before the medical insurance fund pays according to the prescribed proportion. The standard of the amount of hospitalization medical expenses borne by the indivial first is the "starting line" of the medical insurance fund to pay the hospitalization medical expenses of the insured. The inpatient medical expenses below the starting payment standard shall be borne by the patient himself
the starting payment standard and reimbursement proportion of basic medical insurance for urban residents are determined according to the types of insured persons<
one
refers to the medical expenses of less than 180000 yuan that meet the reimbursement scope of students and children in a settlement year. The minimum payment standard of tertiary hospitals is 500 yuan, and the reimbursement proportion is 55%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard in the first-class hospitals, and the reimbursement rate is 65%<
the second
is the elderly over 70 years old. In a settlement year, for medical expenses less than 100000 yuan that meet the reimbursement scope, the minimum payment standard of tertiary hospitals is 500 yuan, and the reimbursement proportion is 50%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard in the first-class hospitals, and the reimbursement rate is 65%
Third, other urban residents. In a settlement year, for medical expenses less than 100000 yuan that meet the reimbursement scope, the minimum payment standard of tertiary hospitals is 500 yuan, and the reimbursement proportion is 50%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 55%; There is no minimum payment standard for the first-class hospitals, and the reimbursement rate is 60%. For urban residents who have been hospitalized for more than two times in a settlement year, starting from the second hospitalization, the standard fee will no longer be charged. If the patient is transferred to another hospital or hospitalized for more than two times, the difference shall be made up according to the prescribed minimum payment standard for transfer to or re admission to the hospital. For example, if a child falls ill and is hospitalized in a tertiary hospital, and the medical expenses that meet the requirements are 60000 yuan, 32725 yuan can be reimbursed × 55%] If you are hospitalized in a first-class hospital and the medical expenses are 5000 yuan, 3250 yuan (5000 yuan) can be reimbursed × 65%