How much can social security be reimbursed for illness?

Employee medical insurance reimbursement standard:

First, the provisions of outpatient and inpatient reimbursement standards:

1, Qifubiaozhun: tertiary hospital 800 yuan, secondary hospital 600 yuan, other 300 yuan;

2. Reimbursement ratio:

A, the minimum payment standard is 6.5438+0.8 million yuan: 70% for third-level reimbursement, 75% for second-level reimbursement and 80% for other reimbursement;

B, 1.8 million yuan or more: 70%.

Remarks:

1. Only one hospitalization Qifubiaozhun is set in a settlement year.

2, a settlement year, family beds and outpatient medical expenses according to the provisions of the hospital, but there is no Qifubiaozhun.

3,180,000 yuan is used for medical assistance for major diseases.

4. The reimbursement rate for children's hospitalization expenses of more than 6.5438+0.8 million yuan is 80%.

Second, the outpatient reimbursement standard:

1, minimum payment standard: 300 yuan;

2. Reimbursement ratio:

A. Individual payment 500 yuan/year: 40% for tertiary hospitals, 50% for secondary hospitals and 70% for others;

B. Individual payment 300 yuan/year: 25% for tertiary hospitals, 35% for secondary hospitals and 60% for others;

Remarks:

1, outpatient qifubiaozhun is set only once in a settlement year;

2. If the insured person voluntarily chooses to go to the community health service institution where he lives, he can implement "two-way referral" in accordance with the regulations, and there is no Qifubiaozhun for outpatient treatment.

3. The reimbursement rate of college students/children's outpatient service is the same as that of individual contributions (500 yuan/year).

The proportion of patients who can be reimbursed after buying social security is:

1, 80% of employees' medical treatment is paid by _ overall fund, and 20% is paid by individuals.

2. For retirees seeking medical treatment, the overall fund pays 85% and the individual pays 15%.

3. Large medical insurance: medical expenses ranging from 30,000 yuan to 654.38+10,000 yuan (inclusive), with 94% of large medical insurance premiums paid by individuals and 6% paid by individuals.

4. Large medical insurance covers medical expenses ranging from 654.38+10,000 yuan to 200,000 yuan (inclusive), with 96% of large medical insurance premiums paid and 4% paid by individuals.

5. Large medical insurance for medical expenses of more than 200,000 yuan, 98% for large medical insurance and 2% for individuals.

Legal basis:

"Several Provisions on Implementing the Social Insurance Law of People's Republic of China (PRC)" Article 8 If the medical expenses incurred by the insured in the agreed medical institutions meet the standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities, they shall be paid from the basic medical insurance fund in accordance with state regulations.