How much out-of-pocket expenses will be reimbursed for medical insurance

1, medical insurance personal out-of-pocket expenses how much to start reimbursement

1, if you are a working employee, to the hospital outpatient, emergency room after the visit to the hospital, more than 2,000 yuan of medical expenses can be reimbursed, reimbursement rate is 50%.

2. If you are a retiree under 70 years old, you can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70 percent.

3. If the retiree is over 70 years old, the reimbursement rate for expenses over $1,300 is 80 percent.

Two, health insurance second reimbursement out-of-pocket expenses of 1300 yuan can be reimbursed. In accordance with the provisions of the current annual first use of basic medical insurance to pay for hospitalization expenses, active and retired personnel starting line amount is 1300 yuan. For the second and subsequent hospitalization, the threshold is set at 50% of the hospitalization cost, which is RMB 650. The maximum payment from the Basic Medical Insurance Co-ordination Fund (for hospitalization expenses) is 70,000 yuan in one year.

The working medical insurance card out-of-pocket expenses accumulated 800 yuan, the retired out-of-pocket expenses accumulated 400 yuan medical insurance automatically open 3000 yuan medical insurance co-ordination fund, after the opening and then see a doctor to dispense medicine out-of-pocket expenses of 15%, the medical insurance reimbursement of 85%.

Medical expenses for hospitalization for serious illnesses are paid in the following ways:

(a) The starting standard is controlled in principle in the city, county, autonomous county employees in the previous year's annual average social wage of 9% -11%.

(b) The maximum payment limit is in principle controlled at 3-5 times of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

(3) Medical fees above the threshold and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees is appropriately taken care of.

The scope of serious diseases, the specific criteria for the starting standard and the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit to be shared by the provincial people's government shall be determined by the provincial people's government.

Three, medical insurance reimbursement need to have what conditions

1, in the designated institutions to obtain medical reimbursement, first of all need to be insured in the basic medical insurance provisions of the designated medical institutions and pharmacies or purchase of medicines, can be reimbursed, otherwise it is unable to reimbursement;

2, belonging to the social security directory in order to obtain reimbursement of the medical insurance, first of all, need the diagnosis and treatment items occurring or the purchase of medicine.

3. In order to be reimbursed by the medical insurance, the medical expenses incurred by the insured person must first reach the starting line stipulated by the social security system, and the part of the medical expenses that exceeds the starting line and is within the limit will be reimbursed and paid by the basic medical fund at a uniform rate. The unified percentage of payment.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China conforms to the standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facilities, as well as the medical expenses for emergency treatment and salvation, and shall be paid out of the basic medical insurance fund in accordance with the state regulations.