What is the proportion of hospitalization reimbursement for on-the-job medical insurance

What is the proportion of hospitalization reimbursement for on-the-job medical insurance

The proportion of hospitalization reimbursement for on-the-job medical insurance varies with regions and policies, but it is usually determined according to the level of medical expenses and medical insurance policies. Generally speaking, the proportion of hospitalization reimbursement for medical insurance is between 50% and 95%. The specific reimbursement ratio and qifubiaozhun may be different due to different regions and medical insurance policies.

I. Reimbursement rate

The reimbursement ratio of in-service medical insurance hospitalization is usually determined according to the level of medical expenses. Generally speaking, the higher the medical expenses, the higher the reimbursement rate. The specific reimbursement ratio may vary according to different regions and different medical insurance policies.

Second, Qifubiaozhun

In-service medical insurance hospitalization usually has a certain threshold, that is, medical expenses can only be reimbursed after reaching a certain amount. The specific minimum payment standard may vary according to different regions and medical insurance policies.

First of all, the level of medical expenses is usually divided into three grades, the first grade is the expenses within the scope of social security, the second grade is the expenses outside the scope of social security, and the third grade is the full out-of-pocket expenses. The expenses of the first and second files can be reimbursed by medical insurance, and the expenses of the third file need to be paid in full.

Secondly, the payment of the insured will also affect the proportion of hospitalization reimbursement for medical insurance. Insured people who have paid medical insurance premiums for 6 months can enjoy medical insurance hospitalization reimbursement, and the reimbursement ratio is usually between 80% and 95%. If the insured fails to pay the medical insurance fee continuously or the payment time is less than 6 months, the reimbursement ratio may be affected, and the specific ratio needs to be determined according to the local medical insurance policy.

To sum up, if you want to know the specific hospitalization reimbursement ratio and Qifubiaozhun of on-the-job medical insurance, it is recommended to consult the local medical insurance department or relevant institutions to obtain the most accurate information.

Legal basis:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "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 30 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (three) shall be borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party. "