How to calculate the proportion of social security reimbursement

The calculation formula of medical insurance reimbursement ratio is: (total expenses-expenses below deductible line-self-funded items) * reimbursement ratio.

Proportion of hospitalization reimbursement

1, a first-class hospital, can be reimbursed 90% if the threshold is exceeded to the maximum payment limit.

2, secondary hospitals, Qifubiaozhun above to 1 ten thousand yuan can compensate 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

3, tertiary hospitals, more than Qifubiaozhun to 5000 yuan can be compensated by 80%; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

4 retirees can increase 5% on the basis of the above reimbursement ratio.

Deductible line for hospitalization reimbursement

1, a tertiary hospital in 200 yuan.

2, the secondary hospital Wu Bai yuan.

3. 800 yuan, a tertiary hospital.

4, malignant tumor patients, in a medical year for many times due to radiotherapy and chemotherapy medical expenses, only calculate a deductible.

The characteristics of social security are as follows:

1. The objective basis of social insurance is the risks existing in the labor field, and the object of insurance is the individual workers;

2. The subject of social insurance is specific. Including workers and employers;

3. Social insurance is compulsory;

4. The purpose of social insurance is to maintain the reproduction of labor force;

The insurance fund comes from the contributions and financial support of employers and workers. Insurance coverage is limited to employees, excluding other social members. The insurance coverage is limited to all kinds of risks in labor risks, excluding other risks such as property and economy.

To sum up, it is Bian Xiao's relevant answer about how to calculate the social security reimbursement ratio, hoping to help you.

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

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.