What is the reimbursement amount of employee medical insurance hospitalization?

The maximum reimbursement for medical insurance for employees is 250,000 yuan. The maximum payment limit of the basic medical insurance fund is 654.38 million yuan, and the social insurance department10.5 million yuan. If the medical expenses exceed the maximum payment limit of the basic medical co-ordination fund, the social security department will reimburse 85% for the expenses below 0-40 thousand yuan, 90% for the expenses below 40-80 thousand yuan, and 95% for the expenses above 80 thousand yuan. The maximum payment limit for each medical year is 6.5438 yuan +0.5 million yuan.

The reimbursement scope of hospitalization medical insurance is as follows:

1, the expenses incurred during the period when the new insured fails to issue the social security card;

2 social security card loss, social security card replacement (replacement) card during the cost of medical treatment;

3, in the designated medical institutions without card emergency medical expenses;

4. Medical expenses during the default period;

5. Expenses incurred during the period of manual reimbursement for medical treatment;

6, in line with the conditions of the city's medical insurance fund payment in the field of medical expenses;

7. The annual expenses shall be declared before June 20th of the following year.

To sum up, medical insurance is mainly divided into employee medical insurance and resident medical insurance, and the reimbursement ratio is also different. According to the level of hospitalization expenses, the reimbursement rate of medical insurance for employees is 85% between 1300 yuan and 30,000 yuan, 90% between 30,000 yuan and 40,000 yuan, 95% between 40,000 yuan and10000 yuan, and 85% between10000 yuan and 300,000 yuan.

Legal basis:

Social insurance law

Article 28

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.