What is the proportion of hospitalization reimbursement for social security and medical insurance?

The reimbursement ratio of basic medical insurance for medical expenses incurred in hospitalization in designated medical institutions within the scope of medical insurance payment is: 90%, 88% and 86% of employees who are insured by medical insurance are hospitalized and the annual accumulated amount is less than 40,000 yuan, respectively, in designated medical institutions at the first, second and third levels before retirement; After retirement (post), 95%, 94% and 93% are reimbursed in the first, second and third-level designated medical institutions respectively; For the part with an annual accumulative total of more than 40,000 yuan, 95% will be reimbursed before retirement and 97% after retirement, regardless of the level of medical institutions. The maximum annual payment limit for employee medical insurance and basic medical insurance is 200,000 yuan. People's Republic of China (PRC) social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

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

The reimbursement scope of medical insurance is limited to hospitalization period and expenses and drug expenses taken out of the hospital. The previous outpatient examination and treatment expenses cannot be reimbursed. The expenses for examination and treatment after discharge cannot be reimbursed.

1. If you have been hospitalized after preliminary examination, try not to do too much examination and treatment in the outpatient clinic. Go to the hospital as soon as possible, and then do detailed examination and treatment after admission. Only the examination and treatment during hospitalization will be reimbursed.

2. Although the medical insurance regulations stipulate the discharge standards and medication standards. But if possible, try to be treated in the hospital and try not to leave the hospital early for other reasons. When you leave the hospital, if possible, ask the doctor to prescribe medicine for a few more days. No longer enjoy reimbursement after coming out.

Legal basis: Article 4 of People's Republic of China (PRC) Social Insurance Law. Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.