安徽医保价格收费标准

In 2024, the individual payment standard for urban and rural residents' basic medical insurance in Anhui Province is 400 yuan per person per year, and the financial subsidy standard is not less than 670 yuan per person per year. Here are the details of Anhui's medical insurance price charging standards:

1. Payment Standards:

• Urban and Rural Residents: In 2024, the financial subsidy for urban and rural residents' medical insurance in Anhui increased by 30 yuan compared to the previous year, reaching not less than 670 yuan per person per year; the individual payment increased by 20 yuan, reaching 400 yuan per person per year. The government subsidy accounts for over 60%, effectively reducing the financial burden on individuals.

• Employees: For employees, the medical insurance premium is jointly paid by the employer and the employee. The specific payment amount is calculated based on the employee's salary. The employer generally pays a certain percentage of the employee's salary (usually around 6% - 10%, with specific rates varying by region), and the employee pays a part (usually around 2%). For example, if an employee's monthly salary is 5000 yuan, the employer may pay around 300 - 500 yuan, and the employee pays 100 yuan.

2. Medical Insurance Benefits:

• Outpatient Services:

• General Outpatient: In the insured city, for policy - compliant general outpatient medical expenses at first - level and below designated primary medical institutions (including community health service centers and township health centers), there is no deductible and no single - time reimbursement limit. The basic medical insurance fund reimburses 60%, with an annual reimbursement limit of 150 yuan. Regions with higher limits can continue to implement the original annual limit.

• Chronic and Special Disease Outpatient: Anhui has a unified catalog, identification criteria, and disease codes for outpatient chronic and special diseases. At designated medical institutions within the insured city, the reimbursement ratio of the basic medical insurance fund for policy - compliant outpatient medical expenses for chronic and special diseases is not less than 60%. For those with multiple outpatient chronic and special diseases, the deductible is calculated only once a year. Currently, each city determines the annual payment limit and deductible independently, gradually moving towards a provincial - level unification.

• "Two Diseases" Outpatient: For patients with hypertension and diabetes ("two diseases") who do not meet the outpatient chronic and special disease identification criteria, at first - level and below designated primary medical institutions within the insured city, the policy - compliant outpatient drug expenses for "two diseases" are paid by the co - ordination fund, with no deductible, and the reimbursement ratio is not less than 50%. Each city sets the reimbursement ratio and annual reimbursement limit for each disease according to the fund's affordability, gradually moving towards a provincial - level unification.

• Inpatient Services:

• General Inpatient: The deductible and reimbursement ratio vary by hospital level. For first - level and below medical institutions and township health centers (community health service centers), the deductible is 200 yuan, and the reimbursement ratio is 90%; for second - level and county - level medical institutions, the deductible is 500 yuan, and the reimbursement ratio is 80%; for third - level (municipal - affiliated) medical institutions, the deductible is 700 yuan, and the reimbursement ratio is 75%; for third - level (provincial - affiliated) medical institutions, the deductible is 1000 yuan, and the reimbursement ratio is 70%.

• Maternity Inpatient: For insured persons' maternity hospitalization, there is a fixed - amount subsidy. The subsidy for normal delivery is 1600 yuan, and for cesarean section is 2400 yuan. If the actual maternity medical expenses during hospitalization are lower than the fixed - amount subsidy standard, the medical insurance fund pays according to the actual amount; if it is higher than the fixed - amount subsidy standard, the medical insurance fund pays according to the fixed - amount standard.

• Accidental Injury Inpatient: For accidental injury hospitalization with no liability from others, it is reimbursed according to the normal inpatient treatment. For accidental injury hospitalization with clear liability from others, according to the liability - sharing ratio divided by relevant departments, for the part of the hospitalization medical expenses borne by the individual beyond the third - party liability, it is reimbursed according to the normal inpatient treatment. If the relevant departments have not divided the liability ratio, the sharing ratio of the medical insurance fund is determined according to mediation documents, legal documents, etc. For accidental injury hospitalization medical expenses where the liability of others cannot be determined, after the insured person promises no liability from others, it is reimbursed according to the normal inpatient treatment.

• Major Illness Insurance:

• General Population: In an insurance year, for the part of the policy - compliant medical expenses of the insured person's self - paid inpatient and outpatient chronic and special diseases that exceeds the deductible of major illness insurance, the major illness insurance fund reimburses by segments. The deductible for major illness insurance is 15,000 yuan. For the part above the deductible within 50,000 yuan, the reimbursement ratio is 60%; for the 50,000 - 100,000 - yuan segment, the reimbursement ratio is 65%; for the 100,000 - 200,000 - yuan segment, the reimbursement ratio is 75%; for the part above 200,000 yuan, the reimbursement ratio is 80%. The annual payment limit of the major illness insurance fund is 300,000 yuan.

• Special Populations: For disadvantaged groups such as extremely poor people, subsistence allowance recipients, and poverty - returning and poverty - causing people, the major illness insurance implements preferential payments, with the deductible reduced by 50%, the reimbursement ratio increased by 5 percentage points, and the cap removed. For rare disease patients, the unified deductible is 20,000 yuan, and the part above the deductible is still reimbursed by segments according to the major illness insurance.

3. Medical Service Item Charges: For some medical service items, Anhui has clear price regulations. For example, starting from January 1, 2025, the highest government - guided price for some inspection items in provincial - level tertiary public hospitals has been adjusted. For tests like total prostate - specific antigen determination (TPSA), free prostate - specific antigen determination (FPSA), neuron - specific enolase determination (NSE), etc., the price is 30 yuan per item (50 yuan for chemiluminescence method).

Anhui's medical insurance price charging standards are designed to balance the interests of the public, medical institutions, and the government, aiming to provide comprehensive medical security for residents and ensure the sustainable development of the medical insurance system. It is recommended that the public understand local medical insurance policies in detail and actively participate in medical insurance to enjoy corresponding medical benefits.