What is the proportion of personal medical social security payment?

The proportion of individual medical social security payment is divided into 50%, 70% and 80% according to factors such as whether the individual reaches retirement age, the stage of retirement age and the difference of medical expenses. But in either case, the maximum outpatient medical expenses is 20,000 yuan.

1. What is the proportion of personal medical social security payment?

Individuals who have not reached retirement age after purchasing medical insurance can be reimbursed for medical expenses of more than 2,000 yuan after going to the hospital outpatient clinic or seeing a doctor, and the reimbursement ratio is 50%. For retirees under the age of 70,1expenses above 300 yuan are reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,1.Expenses above 300 yuan are reimbursed, and the reimbursement rate is 80%. No matter what kind of people, the maximum amount of outpatient medical expenses is 20 thousand yuan.

Among them, the reimbursement standard for employees' hospitalization is related to the different hospitals where the insured persons are located. For example, the threshold for tertiary hospitals is 0-30,000 yuan, employees pay 15%, and medical insurance reimbursement is 85%; The medical expenses of 30,000-40,000 yuan are paid by employees themselves 10%, and the medical insurance reimbursement is 90%; For expenses exceeding 40,000 yuan, medical insurance can reimburse 95% to the maximum payment limit. The proportion paid by retirees is 60% paid by employees, but those below the minimum threshold shall be borne by individuals.

In addition, the reimbursement description of personal medical insurance includes the replacement and installation of special medical materials or disposable medical materials and artificial organs with the unit 1 000 yuan or more. Basic medical insurance, pay 90% according to the domestic general price; The basic medical expenses for the treatment of chronic renal failure, organ transplantation and malignant tumor chemotherapy can be paid by the medical insurance pooling fund for 90%; Outpatient special examination and treatment costs borne by the individual 20%, the basic medical insurance fund to pay 80%.

Two, personal medical insurance purchase considerations

First, pay attention to the age limit of insurance.

Different insurance companies have different regulations on the minimum insurance age. According to different types of insurance, the minimum insurance age generally ranges from 90 days after birth to 16 years old. However, the maximum insurance age stipulated by various insurance companies is roughly the same, which is 65 years old. If your age is not within this range, generally speaking, you are not suitable for insurance. The younger you are, the less the premium will be. It is recommended to take out insurance as early as possible.

Second, pay attention to the obligation to tell the truth.

When concluding an insurance contract, you should truthfully state your physical condition and past medical history to the insurer, so that the insurer can judge whether to accept insurance or under what conditions. Some inpatient medical insurance clauses clearly include some serious diseases (such as congenital diseases, leukemia, etc. ) is within the coverage. So don't conceal the medical history, otherwise the insurance contract will be invalid, and even if there is an insurance accident within the scope of responsibility, the insurance company will not fulfill its obligation to pay compensation.

Third, pay attention to the scope of insurance.

When buying insurance, it is important to know the scope of insurance. Only when an insurance accident occurs within the scope of responsibility will the insurance company fulfill its obligation to pay compensation. For example, the best-selling critical illness insurance in the market is generally the first disease diagnosed after insurance. Such as cancer, stroke and myocardial infarction. Diseases such as asthma and tuberculosis are not covered.

Fourth, pay attention to the wait-and-see period of hospitalization medical insurance.

Fifth, pay attention to the deductible clause.

In short, the proportion of individual medical social security compensation has no fixed value, which depends on everyone's different situation. When applying for medical insurance reimbursement, individuals should understand their own situation and relevant policies for medical insurance reimbursement and prescribe the right medicine. At the same time, individuals should pay attention to their age, obligations and types of insurance when purchasing medical insurance, and don't be careless.