Proportion of medical expenses reimbursed by social security in 2022

Local policies and reimbursement rates are different, and the specific needs are subject to local reimbursement policies. The reimbursement rate of medical insurance outpatient service for employees is roughly as follows: 1. Medical insurance for urban workers: 1. On-the-job employees: 2,000 yuan for outpatient service is free of charge, that is, the part exceeding 2,000 yuan of medical expenses incurred in outpatient service will be reimbursed, and the reimbursement ratio is 50%; 2. Retired employees: The outpatient service fee is 1.300 yuan, that is, only the part that exceeds 1.300 yuan is reimbursed, with 70% for those under 70 years old and 80% for those over 70 years old. 3. Maximum amount: No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20,000 yuan. 2. Medical insurance for urban residents: 1. General outpatient service: within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses paid by the outpatient co-ordination fund are reimbursed at the rate of 60%. The maximum annual payment limit for individuals of the overall fund is 400 yuan. 2. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses meeting the prescribed treatment scope is the same as that for general hospitalization. Third, the new rural cooperative medical system: 1, 60% of the reimbursement for visits to village clinics and village center clinics, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan. 2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan. 3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan. 4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan. 5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan. 6, the township cooperative medical outpatient compensation limit is 5000 yuan. 7. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses that meet the prescribed treatment scope is the same as that for general hospitalization. The State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, demanding the integration of the basic medical insurance system for urban residents and the new rural cooperative medical system, and establishing a unified basic medical insurance system for urban and rural residents.

Legal objectivity:

"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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. Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.