What is the proportion of medical insurance reimbursement?

Medical insurance, referred to as medical insurance, is a kind of social insurance. The reimbursement ratio of medical insurance is:

1. On-the-job employees: Grade-III and Grade-A hospitals, with 90% reimbursement from the overall fund and individual paying10%; Secondary hospitals, 85% of the overall fund reimbursement, individual pays15%; In tertiary hospitals, 80% is reimbursed from the overall fund and 20% is paid by individuals. 2. Retirees: first-class hospitals, with 93% reimbursement from the overall fund and 7% paid by individuals; The secondary hospitals reimbursed 89.5% from the overall fund, and the individual paid10.5%; 86% of the hospitals in Grade III and Grade A are reimbursed from the overall fund, and 14% are paid by individuals.

3. Migrant workers (migrant workers buy foreign accounts in Guangzhou with medical insurance): First-class and first-class hospitals, with 72% reimbursement from the overall fund and 28% paid by individuals; Secondary hospitals, 68% of the overall fund reimbursement, and 32% of the individual pays; In a third-class first-class hospital, 64% is reimbursed from the overall fund and 36% is paid by the individual. Medical insurance reimbursement, simply speaking, is the cost you pay for medical treatment, which is partly borne by the state or unit, and the part of the burden is called reimbursement. China's medical insurance is divided into two parts: individual account and social pooling fund, which are jointly funded by units and individuals in accordance with the prescribed proportion to ensure citizens' basic medical needs. Among them, the overall fund is used to pay the hospitalization expenses, the personal account is used to pay the outpatient and emergency expenses and the drug purchase expenses of designated retail pharmacies, and the expenses that need to be borne by individuals in specific projects of hospitalization and outpatient services are also paid by personal accounts. If the funds in personal accounts are insufficient, they will be paid by individuals.

Legal basis:

Article 28 of the Social Insurance Law

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.