How much medical expenses can employee social security reimburse?

The reimbursement rate and the maximum payment limit of employee medical insurance vary according to factors such as employee type (on-the-job or retired), level of medical institution, and whether it meets specific diseases. The following is the relevant introduction:

Out-patient reimbursement The reimbursement rate of employees in community clinics is 90%, and that in non-community clinics is 70%. Retirees are divided into two groups according to their age: those under 70 years old and those over 70 years old, with reimbursement rates of 90% and 90% respectively.

Hospitalization reimbursement. The reimbursement ratio of employees varies according to the expense range. The reimbursement rate is 1.3 million yuan to 30,000 yuan 85%, 30,000 yuan to 40,000 yuan 90%, 40,000 yuan to 1 10,000 yuan 95%, 1 10,000 yuan to 300,000 yuan 85%.

Proportion of hospitalization reimbursement for retired workers. For retirees hospitalized in tertiary hospitals, the minimum payment is 30,000 yuan, and the employee contribution is 15%, that is, 85% is reimbursed; For expenses ranging from 30,000 yuan to 40,000 yuan, the employee pays 10%, that is, 90% is reimbursed; 95% of expenses exceeding 40,000 yuan to the maximum payment limit can be reimbursed, and employees only need to pay 5%.

Employee medical insurance reimbursement scope:

1, the personal account of employee medical insurance will reimburse the following medical expenses:

2, outpatient and emergency medical expenses;

3, to the designated retail pharmacies to buy drugs;

4, the basic medical insurance fund Qifubiaozhun below the medical expenses;

5, more than the basic medical insurance fund Qifubiaozhun part, according to the proportion of medical expenses that should be borne by individuals.

To sum up, the medical insurance policies in different regions may be different, and the specific reimbursement ratio and maximum payment limit shall be subject to the local medical insurance policies.

Legal basis:

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

Article 30

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

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.