What is the proportion of medical insurance reimbursement?

Medical insurance card reimbursement is generally proportional, generally 60%-70%. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Under what circumstances can it not be reimbursed? 1, not exceeding the deductible. Deductible is the threshold of medical insurance reimbursement, usually between 300- 1500 yuan. The deductible standard of each city is different, which is also linked to the level of the hospital: the deductible of the first-class hospital is the lowest, the deductible of the second-class hospital is in the middle, and the deductible of the third-class hospital is the highest. If the treatment fee does not reach the deductible, then the medical insurance will not be reimbursed. 2, more than the top line can not be reported. The capping line refers to the maximum payment limit of the medical insurance fund, that is, the maximum reimbursement amount that the insured can get from the medical insurance fund within one year. 3. Non-fixed and non-fixed catalogs are not reimbursed. Two designated hospitals and pharmacies need to be approved by the administrative department of social security. Catalogue: drug catalogue, diagnosis and treatment catalogue, scope of medical service facilities and payment standard catalogue.

The money in the medical insurance card can't be taken out. It can only be used to buy drugs in cooperative pharmacies or clinics designated by medical insurance, and pay for outpatient expenses and hospitalization expenses. However, under the following special circumstances, the money in the medical insurance card can be withdrawn: (1) When the cardholder dies, the medical insurance card will be terminated naturally. The guardian or immediate family members can provide relevant death certificates to apply for the remaining amount in the medical insurance card; (2) If the medical insurance is transferred across regions, the amount in the medical insurance card can be applied for withdrawal and then transferred to the medical insurance card that needs to be accepted in different places, which belongs to the continuous payment of medical insurance cards, and the payment period is still accumulated normally; (3) If the cardholder needs to emigrate, he can go through the formalities of returning the medical insurance card and provide relevant supporting documents as required.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.