Proportion of medical insurance reimbursement for employees in Henan Province in 2023

Due to different medical institutions, the proportion of employee reimbursement in Henan Province in 2023 is 45% to 70%.

The proportion of on-the-job workers' general outpatient payment is 70% in primary medical institutions including township hospitals and community health service centers, 60% in secondary medical institutions and 45% in tertiary medical institutions, and the proportion of retirees' payment is increased by 5% according to the level of medical institutions; Xi employee medical insurance outpatient co-ordination treatment deductible line for 200 yuan; The maximum payment limit for each person in the general outpatient service of on-the-job employees is 2000 yuan per year, and the maximum payment limit for retirees is 2500 yuan. The annual maximum payment limit is valid in the current year, and it is not rolled over or accumulated.

Proportion of medical insurance reimbursement:

The proportion of medical insurance reimbursement is determined according to local policies and regulations, and there may be differences in the proportion of reimbursement in different regions. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%;

2. Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, the proportion of medical insurance reimbursement in different regions is different. Urban and rural residents living in different places for a long time, urban and rural residents over 60 years of age and women over 55 years of age, urban and rural residents working in different places and their accompanying children have registered for medical treatment in different places. The deductible standards for hospitalization in the registered places are 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan respectively, and the reimbursement ratio is implemented by local designated hospitals.

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.