Social security card insurance reimbursement ratio

Social security card reimbursement is generally proportional, generally 60%-70%.

1. In a settlement year, medical expenses less than 654.38+10,000 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

2. The reimbursement rate of social security card hospitalization is: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total hospitalization reimbursement of 300,000 yuan. Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time.

3. Continuous payment is linked to the reimbursement ratio. After two years of continuous insurance, the reimbursement rate increased to 765,438+0%, and after four years of continuous insurance, the reimbursement rate increased to 72%, and so on. It should be reminded that in different cities, the reimbursement ratio of social security cards is different, which is mainly related to the local medical insurance benefits.

Matters needing attention for hospitalization reimbursement of social security card:

1, different hospitals have different reimbursement rates for medical insurance. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not medical insurance and cannot be reimbursed.

2. If you have paid your own medical expenses, how can you go through the social security process? There are two situations in which medical expenses are paid first and then reimbursed by medical insurance: first, they can be reimbursed by bills; Second, the hospital directly settled with social security. Either way, reimbursement should be made according to the corresponding specified time and information. Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

legal ground

Article 28 of the Social Insurance Law The 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.

Twenty-ninth, the medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency and the 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.