The scope and amount of reimbursement for social security and medical insurance

Legal analysis: 1. The payment scope of basic medical insurance pooling fund and individual account is different, and the accounting of reimbursement is also carried out separately. Medical expenses that meet the scope of medical insurance fund payment shall be compensated according to the basic medical insurance drug list, service facilities range, diagnosis and treatment project list and payment standard. 2. First, the proportion of hospitalization reimbursement. First-class hospitals, more than Qifubiaozhun to the highest payment limit can be reimbursed 90%; For the second-level hospital, the part above the deductible line 1 10,000 yuan can be compensated by 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%; For tertiary hospitals, 80% can be compensated for the part exceeding the minimum deductible of 5,000 yuan; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%; Retirees can increase 5% on the basis of the above reimbursement ratio. Two, hospitalization reimbursement deductible. Two hundred yuan for a first-class hospital; Five hundred yuan, a secondary hospital; 800 yuan, a tertiary hospital; For patients with malignant tumors, the medical expenses generated by multiple radiotherapy and chemotherapy in a medical year are only calculated once.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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.