What is the reimbursement ratio of new medical insurance in 2023?

The proportion of medical insurance reimbursement in 2023 is as follows:

The proportion of medical insurance reimbursement is determined according to local policies and regulations, and there may be differences in the proportion of reimbursement in different regions. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%;

2. Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

Medical insurance can reimburse the following items:

1. Hospitalization: Medical insurance can guarantee hospitalization caused by illness or accident, including medical service fees, medicine fees, materials fees, examination fees, etc.

2. Outpatient treatment: Medical insurance can reimburse medical expenses for outpatient treatment, including registration fees, inspection fees, inspection fees, medicine fees, etc.

3. Physical examination: Medical insurance can reimburse medical examination expenses paid by individuals at their own expense.

It should be noted that there may be differences in different regions and policies, and the specific scope and standard of reimbursement shall be subject to local policies.

To sum up, the proportion of medical insurance reimbursement in different regions is different. Urban and rural residents living in different places for a long time, urban and rural residents over the age of 60 and women over the age of 55, urban and rural residents working in different places and their accompanying children have registered for medical treatment in different places. The hospitalization deductible standards for registered medical treatment places are 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan respectively, and the reimbursement ratio is implemented by the designated hospitals in the local urban areas.

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.