In 2025, the hospitalization reimbursement ratios in Cangzhou vary based on different insurance types and hospital levels. For urban employees' medical insurance, at tertiary hospitals, the reimbursement ratio for active employees is 90% and for retirees is 93%; at secondary hospitals, both active employees and retirees have a reimbursement ratio of 95%; at primary hospitals, the ratio for both is 98%. For urban and rural residents' medical insurance, the reimbursement ratio at tertiary hospitals is 65%, at secondary hospitals is 80%, and at primary hospitals (including township health centers and community health service centers) is 90%.
Here are the details of the reimbursement ratios in Cangzhou:
- Employee Medical Insurance
- Tertiary Hospitals: Active employees can be reimbursed at a ratio of 90%, and retirees at 93%. For example, if an active employee spends 10,000 yuan on hospitalization in a tertiary hospital, the reimbursable amount is yuan (assuming all expenses are within the reimbursement scope).×90%=
- Secondary Hospitals: Whether active employees or retirees, the reimbursement ratio is 95%.
- Primary Hospitals: Both active employees and retirees enjoy a high reimbursement ratio of 98%.
- Residents' Medical Insurance
- Tertiary Hospitals: The reimbursement ratio is 65%.
- Secondary Hospitals: The reimbursement ratio is 80%.
- Primary Hospitals: The reimbursement ratio is 90%, which is relatively high, aiming to encourage residents to seek medical treatment at the grass - roots level.
- Factors Affecting Reimbursement
- Medical Service Items: Using "Class B" drugs in the basic medical insurance drug list, 5% of the cost is first paid by the insured, and the remaining part is paid according to the regulations of basic medical insurance. For large medical equipment inspection and treatment items within the scope of basic medical insurance partial payment (Class B), 10% of the cost is first paid by the insured, and the rest is paid as per the regulations.
- Medical Materials: For employees' medical insurance, for disposable medical materials, if the total amount is 5000 yuan or less, the individual pays 10% first; for 5000 - 10000 yuan (including 10000 yuan), the individual pays 15% first, and so on. For residents' medical insurance, the self - payment ratios for different amount ranges of disposable medical materials are also clearly defined.
- Hospitalization Times: For employee medical insurance, the first - time hospitalization deductible in tertiary hospitals is 900 yuan, the second - time is 450 yuan, and the third - time and subsequent times are 0 yuan. For residents' medical insurance, the deductible standards also vary according to the number of hospitalizations.
- Special Cases
- Maternity Expenses: For female employees, there are different limit payment standards for natural childbirth, artificial intervention childbirth, cesarean section, and cesarean section with other surgeries. For example, the limit for natural childbirth is 2000 yuan, and within this limit, the actual medical expenses are paid, and the excess part is borne by the individual.
- Chronic Disease and Severe Disease Outpatient Treatment: For employee chronic diseases, the deductible in a year is 200 yuan. For eligible medical expenses above the deductible, the co - ordination fund payment ratio is 80% for active employees and 83% for retirees. For residents' chronic diseases, the deductible is 200 yuan, and the medical insurance fund payment ratio is 70%. For "severe disease" outpatient treatment, the deductible (threshold fee) in a year is 900 yuan for employees and 1800 yuan for residents, and the co - ordination fund payment ratio for eligible medical expenses above the deductible is the same as the hospitalization standard.
- Uremia Outpatient Dialysis: For uremia outpatient dialysis treatment, for urban employees' medical insurance, the co - ordination fund pays 95% and the individual bears 5%; for urban and rural residents' medical insurance, the co - ordination fund pays 80% and the individual bears 20%.
When seeking medical treatment, insured persons should understand relevant policies in advance, choose designated medical institutions, and keep relevant receipts and materials to ensure smooth reimbursement. Different situations may lead to differences in actual reimbursement amounts, so it is recommended to consult the local medical insurance department for details.