Proportion standard of medical insurance reimbursement for flexible employees

The proportion standard of medical insurance reimbursement for flexible employees is as follows:

1. reimbursement ratio of outpatient medical expenses: generally ranging from 50% to 90%. Among them, the reimbursement rate of western medicine and Chinese patent medicine is generally high, and the reimbursement rate of medical service fees is generally low;

2. The reimbursement rate of hospitalization medical expenses: generally between 60% and 80%, in which the reimbursement rate of basic medical insurance is generally between 50% and 70%, and the reimbursement rate of supplementary medical insurance is generally between10% and 30%;

3. The reimbursement rate of medical expenses for special diseases: generally ranging from 80% to 90%, and the specific standards may be adjusted due to different regions and policies.

The reimbursement scope of medical insurance includes:

1. Outpatient medical expenses: including outpatient consultation expenses, examination expenses, laboratory expenses, treatment expenses, operation expenses, rehabilitation expenses, etc.

2. Hospitalization medical expenses: including hospitalization expenses, hospitalization expenses, bed expenses, operation expenses, laboratory expenses, inspection expenses, etc.

3. Special treatment expenses: including liver transplantation, bone marrow transplantation, organ transplantation and other special treatment expenses;

4. Chinese medicine and ethnic medicine fees: including Chinese medicine, ethnic medicine service fees and herbal medicine fees.

5. Reproductive health care expenses: including pre-pregnancy examination, pregnancy examination, delivery expenses, caesarean section expenses, abortion operation expenses, etc.

6. Hospice care costs: including hospice care costs for patients with advanced cancer;

7. Medical assistance expenses: including the medical expenses of poor people and people with special difficulties who meet the conditions of assistance.

To sum up, the scope of medical insurance in different regions may be different, and it will be different according to different types of medical insurance. Therefore, when enjoying medical insurance benefits, we should understand the local medical insurance policies and regulations to avoid economic losses caused by not knowing the policies and regulations.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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 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.