How much can medical insurance reimburse for cholecystectomy?

The proportion of medical insurance reimbursement for lens capsulotomy depends on the situation, as follows:

1, the proportion of medical insurance reimbursement for cholecystectomy is determined according to the specific regional conditions;

2. The reimbursement amount of medical insurance is: reimbursement amount = (total medical expenses-deductible-deductible) * reimbursement ratio, and the reimbursement ratio is about 85%;

3. If the medical expenses incurred by the parties exceed the maximum payment limit of the basic medical pooling fund, 85% of the expenses below RMB 0-40,000 yuan shall be reimbursed by the social insurance department, 90% of the expenses below RMB 40,000-80,000 yuan, and 95% of the expenses above RMB 80,000 yuan.

Proportion of reimbursement for outpatient and emergency expenses

1. The medical expenses above 1800 yuan can only be reimbursed after the on-the-job employees see a doctor in the emergency department of the hospital, and the reimbursement rate is 50%.

2. Retirees under the age of 70,1.Expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%.

3. Retirees over 70 years old,1.Expenses above 300 yuan can be reimbursed by 80%.

Proportion of reimbursement for hospitalization expenses

1, the standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. If you live in a tertiary hospital, the employee pays 15%, which is 85% of the reimbursement, from the minimum threshold to 30,000 yuan.

2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;

3, more than 40000 yuan to the maximum payment limit, 95% can be reimbursed, employees only need to pay 5%.

4. The individual contribution ratio of retirees is 60% of the on-the-job (i.e. the above) employees, but all below the threshold is paid by individuals.

Therefore, medical insurance also has two major functions of insurance:

Risk transfer and compensation transfer. That is, the economic losses caused by individual disease risks are distributed to all members threatened by the same risks, and the economic losses caused by diseases are compensated by centralized medical insurance funds.

To sum up, medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance in the form of contracts and establishes medical insurance funds; When the insured goes to a medical institution for medical treatment, the medical insurance institution will give him some economic compensation.

Therefore, medical insurance also has two functions of insurance: risk transfer and compensation transfer. That is, the economic losses caused by individual disease risks are distributed to all members threatened by the same risks, and the economic losses caused by diseases are compensated by centralized medical insurance funds.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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

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.