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Zhejiang provincial basic medical insurance treatment summary table

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Zhejiang provincial basic medical insurance treatment summary table

Category

general outpatient

outpatient prescribed diseases

inpatient

major medical insurance fund

In-service

Retirement

In-service

Retirement

In-service

Retirement

Employee

Children Coordinated

No fixed income Retired spouse

Payment method



Type of institution

The current year's account will be used first, and if the current year's account is not sufficient to pay, the individual will bear the starting standard first, and the part above the starting standard will be paid by the fund and the individual.

Settlement according to inpatient reimbursement ratio, but no starting line

The starting standard is calculated once for a settlement year (natural year), and for two or more hospitalizations, the starting standard is calculated according to the higher-grade medical institutions; out-of-pocket medical expenses below the starting standard are first paid by the calendar year account, and any shortfall in payment is borne by the individual, and the individual out-of-pocket ratio is reduced by half for the elderly before the founding of the country.

The outpatient and inpatient outpatient and inpatient outpatient medical expenses paid by the individual, out-of-pocket expenses and special medication for major medical insurance.

Starting line

1000

300(including old workers before the founding of the People's Republic)

None

Level 3 medical institution: 800 yuan

Level 2 medical institutions: 500 yuan

Level 1 medical institutions and others below: 300 yuan

30,000

Level 3 medical institutions

75% fund payment, 25% individual out-of-pocket

Refer to hospitalization

Starting line - 40,000 (including 40,000), 82% in service, 88% in retirement; over 40,000, 88% in service, 94% in retirement

30,000 - 150,000 (including 150,000) 60%

150,000 - 300,000 (including 300,000) 70%

300,000 - 450,000 (including 450,000) 80%

Over 450,000 self-pay

Level 2 medical institutions

85% fund payment, 15% individual out-of-pocket

Refer to hospitalization

Starting line - 40,000 (including 40,000), 85% in service, 90% in retirement; over 40,000, 90% in service, 95% in retirement 

Retail pharmacies

85% fund payment, 15% individual out-of-pocket

Refer to hospitalization

None

Primary and other medical institutions

95% fund payment, 5% individual out-of-pocket

Refer to hospitalization

Starting line - 40,000 (including 40,000), 88% in service, 92% in retirement; above 40,000, 92% in service, 96% in retirement 

Social medical service providers

95% fund payment, 5% individual out-of-pocket

Refer to hospitalization

Starting line - 40,000 (including 40,000), 88% in service, 92% in retirement; above 40,000, 92% in service, 96% in retirement

Civil service benefits

Basic medical benefits:           1. Outpatient and inpatient starting payment below 75% for Level 3, 85% for Level 2, 95% for Level 1 and others

2. outpatient and hospitalization out-of-pocket expenses below the starting standard + major medical insurance out-of-pocket expenses below the starting standard and co-payments, 90% of which exceeds RMB 1,000.

3.Relief-type medical assistance: After the treatment of serious illnesses of the participants must be covered by basic medical insurance, major medical insurance and basic medical assistance, the remaining out-of-pocket medical expenses, the individual's out-of-pocket expenses of 20,000 yuan (including 20,000 yuan)

             The part below is paid by the individual, and the part below 20,000 - 200,000 yuan, 60% subsidy.