How much is reimbursed by inter provincial medical insurance for hospitalization, and how much can b

The reimbursement ratio is 88% for the threshold fee above 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10,000 yuan, and 95% for more than 10,000 yuan to the maximum payment limit, of which 80% for Class B drugs, 70% for valuable drugs, and 70% for special inspections and special **.

Extended information: direct settlement of cross-provincial and non-local medical treatment refers to the basic medical insurance (including NCMS) Participating patients go to designated medical institutions outside the overall planning area for medical treatment, and after going through standardized filing procedures or referral procedures, patients only need to pay the self-paid part of the medical expenses when settlement, and the expenses within the scope of basic medical insurance compensation can be directly compensated at the hospital window. At present, the direct settlement service of inter-provincial inpatient expenses has been opened nationwide, and some regions have begun to pilot the direct settlement of inter-provincial outpatient expenses.

The service targets are retirees, long-term residents, permanent staff and referrals who participate in the medical insurance for urban employees or urban and rural residents. Participants who participate in the new rural cooperative medical insurance, go out due to serious illness, long-term residence in other places, emergency treatment in other places, and have cross-provincial and remote medical needs.

Medical expenses in the personal account of medical insurance can be regularly transferred to the Zigui Medical Insurance Bureau, and hospitals in other provinces should be designated hospitals for local medical insurance.

The first step in the reimbursement process of medical insurance for cross-provincial and non-local medical treatment is to file for the record, and the insured person should bring his or her social security card, ID card, long-term residence certificate in another place, etc., to the medical insurance agency in the place of insurance to go through the formalities. At present, nine provinces and municipalities in Inner Mongolia Autonomous Region, Zhejiang, Hunan, Hainan, Chongqing, Sichuan, Yunnan, Gansu and Ningxia Hui Autonomous Region have unified online filing services to facilitate online application for insureds.

The second step is to select the point, and the designated hospital should be selected when filing, and the doctor can only be reimbursed in the designated hospital in the future. The third step is to seek medical treatment with a card, as long as the patient seeks medical treatment in a designated hospital, as long as he does a good job of filing and bringing his social security card for admission registration and discharge settlement, he can directly settle the medical expenses, and there is no need to pay in advance or go back and forth.

Note: For admission and settlement, you must bring your social security card, otherwise you may be mistaken for a self-paying person, and it will be difficult to transfer to a patient with inter-provincial direct settlement when you are discharged. If you are worried about forgetting to bring your social security card, you can apply for an electronic social security card on WeChat or Alipay, and the application entrance of both platforms is "city service".

There are two main steps for reimbursement of medical insurance in different places:

1. Handle the record. That is, inform the insurance department that you want to go to ** and why you need to seek medical treatment in a different place.

2. Settlement with a card. After the filing is completed, with the medical insurance electronic voucher or social security card, the medical institution that has opened a designated medical institution for cross-provincial and remote medical treatment in the place of medical treatment can realize the direct settlement of medical expenses.

At present, the direct settlement of cross-provincial and non-local medical expenses is divided into two categories: outpatient and inpatient. How much can be reported mainly depends on two points: the scope of payment and the payment policy.

Among them, the scope of payment refers to the drug list, medical service items and medical consumables of medical insurance, etc., which determine which can be reimbursed for medical treatment in other places.

The payment policy refers to the starting line, payment ratio and maximum payment limit of medical insurance**, etc., which are mainly implemented according to the medical insurance policy of the insured place, which determines how much you can reimburse.

In the list of medical insurance drugs, the category A catalogue can be fully included in the reimbursement category, and the category B catalogue needs to pay a certain percentage of itself, and the remaining part can be reimbursed according to a certain percentage.

Moreover, the catalogue of diagnosis and treatment items such as ** fee, medical record production cost, beauty items, and cosmetic surgery items cannot be reimbursed. The list of medical service facilities such as ambulances, inpatient escorts, and laundry expenses is also not reimbursable.

Inter-provincial medical insurance reimbursement ratio: 88% of the threshold fee above 3,000 yuan; 3000-5000 yuan reported 90%; 5,000-10,000 yuan reported 92%; 95% of the maximum payment limit for more than 10,000 yuan; Among them, 80% for Class B drugs, 70% for valuable drugs, and 70% for special inspections and special **.

Article 28 of the Social Insurance Law is in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with national regulations from the basic 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 blind social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

The proportion of medical insurance reimbursement in other places is generally 70 to 95.

For treatment in other places, there are two kinds of conditions that can be reimbursed: one is that the hospital where the insurance is located has issued a transfer procedure, and the other is to seek emergency treatment in other places, and the medical records need to consult the local medical insurance department. You need to bring the emergency certificate of treatment at the local hospital, a copy of the medical record of hospitalization, a discharge summary, etc., as well as a medical bill, medicines, and checklists.

In terms of the payment policy of direct settlement of cross-provincial and non-local medical treatment, the medical expenses of hospitalization, general outpatient and outpatient chronic diseases directly settled by cross-provincial and non-local medical treatment shall in principle be subject to the payment scope and relevant regulations stipulated by the place of medical treatment, and the relevant policies such as the minimum payment standard, payment ratio, maximum payment limit, and outpatient chronic disease scope stipulated by the place of insurance shall be implemented.

Cross-provincial and remote medical treatment settlement process:

The first is to file first. Before the insured person seeks medical treatment in another province or other places, he or she can go through online and offline channels such as the national medical insurance service platform APP, the national remote medical treatment filing applet, the *** client applet, or the window of the handling agency in the place where the insurance is insured.

The second is the selected point. After the insured person completes the filing for medical treatment in other places, all inter-provincial networked designated medical machines opened in the place of filing can enjoy the inter-provincial direct settlement service of hospitalization expenses.

The third is to seek medical treatment with a code card. Participating in the chain insurance personnel are required to present valid vouchers such as medical insurance electronic vouchers or social security cards when they register for admission, discharge and outpatient settlement.