Proportion of medical expenses reimbursed by social security in Guangzhou

The proportion of medical insurance reimbursement is 85%. If it exceeds the basic limit, the social security department will reimburse 85% for expenses below RMB 0-40,000, 90% for expenses below RMB 40,000-80,000 and 95% for expenses above RMB 80,000.

First, the basic medical insurance for urban workers and the medical insurance for urban flexible employees (hereinafter referred to as "the insured"), the Qifubiaozhun for the basic medical expenses of each hospitalization is adjusted as follows:

(1) On-the-job employees: 400 yuan, a first-class medical institution; 800 yuan, a secondary medical institution; Tertiary medical institutions 1600 yuan.

(2) Retirees: 280 yuan, a first-class medical institution; 560 yuan, a secondary medical institution; Tertiary medical institutions 1 120 yuan.

(III) Basic medical care for migrant workers in Guangzhou (that is, those who have purchased medical insurance for migrant workers in Guangzhou), and the minimum payment standard of the basic medical expenses pooling fund for each hospitalization is adjusted to: 200 yuan, a first-class medical institution; 400 yuan, a secondary medical institution; 800 yuan, a tertiary medical institution.

Proportion of hospitalization reimbursement in Guangzhou (compared with hospitalization reimbursement enjoyed by purchasing basic medical insurance)

1. On-the-job employees: Grade-III and Grade-A hospitals, with 90% reimbursement from the overall fund and individual paying10%; Secondary hospitals, 85% of the overall fund reimbursement, individual pays15%; In tertiary hospitals, 80% is reimbursed from the overall fund and 20% is paid by individuals.

2. Retirees: first-class hospitals, with 93% reimbursement from the overall fund and 7% paid by individuals; The secondary hospitals reimbursed 89.5% from the overall fund, and the individual paid10.5%; 86% of the hospitals in Grade III and Grade A are reimbursed from the overall fund, and 14% are paid by individuals.

3. Migrant workers (migrant workers buy foreign accounts in Guangzhou with medical insurance): First-class and first-class hospitals, with 72% reimbursement from the overall fund and 28% paid by individuals; Secondary hospitals, 68% of the overall fund reimbursement, and 32% of the individual pays; In a third-class first-class hospital, 64% is reimbursed from the overall fund and 36% is paid by the individual.

Remarks: (1) On-the-job employees refer to those who have purchased social security for employees in Guangzhou.

(2) First-class hospitals refer to community hospitals and relatively low-level hospitals. Tertiary hospitals refer to national tertiary hospitals, such as Guangdong Provincial People's Hospital and First Hospital of Traditional Chinese Medicine.

(3) The Qifubiaozhun of the overall fund means that when the hospitalization expenses exceed the above standards, the excess can be reimbursed.

The proportion of outpatient reimbursement in Guangzhou (compared with the proportion of medical insurance reimbursement in Guangzhou):

General outpatient treatment: 1 employee (who has purchased social security for Guangzhou employees) and retirees, 65% is reimbursed by community hospitals and 50% by other medical institutions.

2. For flexible employees (those who go to the Social Security Bureau to purchase social security by their own household registration in Guangzhou) and migrant workers (those who purchase medical insurance for migrant workers), 55% will be reimbursed by community hospitals and 40% by other medical institutions.

Legal basis:

Opinions on integrating the basic medical insurance system for urban and rural residents

Article 27 The insured residents' hospitalization medical expenses within the policy scope of the designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.