How much will the medical insurance reimburse patients for 5 years?

1. The so-called "Gate" outpatient special disease means that after you go through the "Gate registration", the proportion of personal responsibility for card treatment is calculated according to the proportion of "Gate", to put it bluntly, it is more than the "Gate" reimbursement, and the personal burden is less. If a person has both Gate and non-Gate, of course, he can see it at the same time, but some drugs do not meet the payment scope of the medical insurance catalog of "Gate", so they cannot be paid according to the proportion of "Gate".

Personal responsibility: Expenses above the threshold (after deducting the threshold fee) below the maximum payment limit, the overall payment standard is 85 for employees, 90 for retirees, and 95 for veteran workers who participated in revolutionary work before the founding of the People's Republic of China. 2. Limits:

The maximum limit of Gate University is 5,000 yuan, and the maximum limit of Gate and hospitalization is 5.

50,000 yuan, large amount of medical assistance: 10,000 yuan offline, upper limit 250,000 yuan. 3. Of course, the medical insurance card cannot be replaced in principle, but if you have acquaintances, it is not completely impossible, and there is really a call that I don't understand: 12333.

**Tianjin.com: Gate medical treatment limit card swiping drug fee of more than 10,000 yuan no longer enjoy instant settlement The reporter found in the interview that among the many insurance fraud cases, the use of diabetes insurance to defraud the insurance to prescribe drugs is the most common. Many diabetic patients or their family members frequently prescribe medicines, prescribing half a year or even a year's amount of drugs in a month, and then resell the drugs to defraud the medical insurance funds.

Hello dear, glad to answer for you. The reimbursement expenses for special outpatient services in one year are as follows: 1. Within one year, the minimum payment standard is 500 yuan, and the part exceeding 500 yuan will be reimbursed 85% of the outpatient medical expenses for diseases managed by Category A, and 75% for the outpatient medical expenses of diseases managed by Category B; 2. The outpatient fee for special diseases and the inpatient medical fee paid by the overall plan are combined, and the maximum payment limit within one year is 50,000 yuan.

The part exceeding 50,000 yuan will be reimbursed by the large sliding amount of medical assistance according to the regulations. Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance**. Article 29 The medical expenses of the insured persons shall be paid by the basic medical insurance, and the social insurance agency shall directly settle the settlement with the medical institutions and drug business units.

Hope it helps.

Hello dear, glad to answer for you. The reimbursement expenses for special outpatient services for one year are as follows: 1. Within one year, the minimum payment standard is 500 yuan, and the part exceeding 500 yuan Zhengqing will be reimbursed 85% of the outpatient medical expenses of the diseases managed by Category A, and 75% of the outpatient medical expenses of the diseases managed by Category B; 2. The outpatient fee for special diseases and the inpatient medical fee paid by the overall plan are combined, and the maximum payment limit within one year is 50,000 yuan.

The part exceeding 50,000 yuan will be reimbursed by the large amount of medical assistance according to the regulations. Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical source treatment expenses, in accordance with national regulations from the basic pre-medical insurance **. Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

Hope it helps.

For some particularly expensive serious diseases, China will establish a supplementary medical insurance reimbursement system, on the basis of basic medical insurance reimbursement, reimbursement, requiring the actual reimbursement ratio to not be less than 50%. Six departments, including the Ministry of Health, the Ministry of Finance, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs, and the Insurance Regulatory Commission, issued the "Guiding Opinions on Carrying out Serious Illness Insurance for Urban and Rural Residents" to avoid poverty due to illness and return to poverty due to illness. Key points of the new policy for serious illness insurance for urban and rural residents:

1. Insured persons of urban residents' medical insurance and NCMS. Second, the funds will be allocated from the medical insurance for urban residents and the New Rural Cooperative Medical System, and the burden of individual contributions will not be increased. Third, the high medical expenses of patients with the standard of protection are judged to exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents in the previous year, and the specific amount shall be determined by the local government.

Fourth, the actual payment ratio of insurance at the level of protection shall not be less than 50%; In principle, the higher the medical fee, the higher the payment rate. Fifth, the way to undertake** department to determine the reimbursement and other policies, through the bidding to select the commercial insurance institutions to undertake. It is understood that at present, there are more than 50 kinds of diseases in China that may cause some families to become poor and return to poverty due to illness.

The state said yesterday that it will carry out serious illness insurance to reimburse urban and rural residents for high medical expenses incurred due to serious illness, the purpose of which is to avoid poverty due to illness and return to poverty due to illness. The protection object of critical illness insurance is the insured of urban residents' medical insurance and NCMS, and the funds required are allocated from urban residents' medical insurance and NCMS**, and there is no additional burden of individual payment. It is estimated that the annual per capita disposable income of urban residents or the annual per capita net income of farmers can be used as the standard for catastrophic medical expenditure of local families.

When the insured patient's personal medical expenses exceed this standard, it is likely to leave the family in financial hardship. Critical illness insurance will reimburse the eligible medical expenses borne by this small group of people on the basis of the basic medical insurance reimbursement, and the actual reimbursement ratio is required to be no less than 50%. The compliant medical expenses here are not limited to the scope of the basic medical insurance policy, but in order to avoid waste and excessive burden, items that are not necessary for the basic ** are not included in the scope of reimbursement.

In accordance with the provisions of the document, the balance of the critical illness insurance shall be handed over to the commercial insurance institution for management, and the method of purchasing critical illness insurance from the commercial insurance institution shall be adopted. Commercial insurance institutions undertaking critical illness insurance must have operated special health insurance business in China for more than 5 years; Have a complete service network and strong medical insurance professional ability; Equipped with full-time service personnel with medical and other professional backgrounds; It can realize the separate accounting of serious illness insurance flushing business and so on. At the same time, it is necessary to reasonably control the profitability of commercial insurance institutions, and provide "one-stop dismantling" instant settlement services to ensure that the masses can enjoy serious illness insurance benefits conveniently and in a timely manner.