How much can hospitalization social security be reimbursed?

The amount of reimbursement for hospitalization social security is as follows:

1, individuals have to wait for 6 months to pay social security, and the company's insurance will take effect the next month; After paying social security, the expenses after 6 months can be reimbursed; The expenses insured within 60 days after unemployment or termination of labor relations can be directly reimbursed;

2. If the hospitalization expenses exceed the deductible, the reimbursement ratio is generally around 80%;

3. The hospitalization expenses in the first-level hospital are up to 30,000 yuan, and the reimbursement ratio is 90%, 30,000 to 40,000 yuan is 95%, and over 40,000 yuan is 97%;

4. If the deductible line of secondary hospitals is below 30,000 yuan, the reimbursement rate is 87%, 30,000 to 40,000 yuan is 92%, and more than 40,000 yuan is 97%;

5, tertiary hospital expenses in the deductible to 30000 yuan, the reimbursement rate is 85%, 30000 to 40000 yuan is 90%, more than 40000 yuan is 95%;

6. Deductible for the first time 1.300 yuan, followed by 600 yuan.

Scope of social security reimbursement:

1, the scope of social security reimbursement usually includes outpatient expenses, hospitalization expenses, drug expenses and special treatment expenses;

2. The social security policies in different regions are different, and the reimbursement ratio and capping line may be different;

3. Social security reimbursement usually has a deductible line, and medical expenses below the deductible line are not reimbursed;

4. The difference between some self-funded drugs and senior wards is not within the scope of social security reimbursement;

5. Social security reimbursement is also affected by individual social security contributions in the current year and historical cumulative payment years.

To sum up, the reimbursement of hospitalization social security needs to take effect after the individual pays the fee for 6 months or the next month when the unit participates in insurance, and can be directly reimbursed within 60 days after unemployment or termination of labor relations; The first time on the pay line 1.300 yuan, then 600 yuan. Different levels of hospitals have different reimbursement rates. The reimbursement rate of 30,000 yuan in first-class hospitals is 90%, 87% in second-class hospitals and 85% in third-class hospitals, and the reimbursement rate increases to 95%-97% with the increase of expenses.

Legal basis:

People's Republic of China (PRC) social insurance law

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.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid from the industrial injury insurance fund.

(2) borne by a third party.

(three) shall be borne by the public health.

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.