Jiangsu Medical Benefits Insurance 1 reimbursement rate

Legal analysis: 1, the basic medical insurance coverage responsibility: cover hospitalization, outpatient treatment incurred within the medical insurance personal out-of-pocket medical expenses and the use of national negotiation dual-channel drug costs, after deducting the 10,000 deductible, 100,000 and within the reimbursement of 65%, more than 100,000 reimbursement of 77%, the maximum reimbursement of 1,000,000 yuan. People with pre-existing conditions are reimbursed at a 10% reduction in the reimbursement rate.

2. Liability for coverage outside the scope of basic medical insurance: reimbursement of medical expenses incurred outside the scope of medical insurance for hospitalization or outpatient services, after deducting the 20,000 deductible, 55% reimbursement for $100,000 and below, 67% reimbursement for more than $100,000, and maximum reimbursement of $1,000,000. People with pre-existing conditions are reimbursed at a 10% reduction in the reimbursement rate.

3. Re-insurance for Major Diseases: After the above two expenses are reimbursed, the remaining personal burden of treatment expenses can be reimbursed by the Major Diseases in the insurance responsibility, after deducting the 50,000 deductible, reimbursement will be made at 45%, and the maximum reimbursement will be made at 1 million a year, and the reimbursement rate for people with pre-existing conditions will be reduced by 10%.

4, rare disease medication supplemental liability: including

including six rare disease medication, the sum insured is 200,000, less 50,000 deductible at 45%.

Legal basis: "The Chinese People's **** and the State Regulations on Basic Medical Insurance for Urban Workers"

Article 28 Individual account is used to pay for medical expenses outside the scope of payment by the integrated fund; any shortfalls in the payment of the individual account shall be borne by the person himself/herself.

Article 29 Medical fees for hospitalization for serious illnesses shall be paid as follows:

(1) The starting standard shall be controlled, in principle, at 9-11% of the average annual social wage of employees in cities, counties and autonomous counties in the preceding year.

(b) The maximum payment limit is in principle controlled at 3-5 times of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

(3) Medical fees above the starting standard and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees is appropriately taken care of.

The scope of serious diseases, the specific criteria for the starting standard and the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit to be shared shall be determined by the provincial people's government.

Article 30 The coordinated fund shall not pay for medical expenses below the starting payment standard and above the maximum payment limit.