How much can surgical social security be reimbursed?

According to the different types of social security contributions, the reimbursement ratio is also different.

Detailed rules for reimbursement of hospitalization operation are as follows:

I. Rural medical insurance: hospitalization

1. Reimbursement scope: medical expenses: supplementary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance, etc. 200 yuan.

2. Operation expenses (refer to national standards, those exceeding 1 ,000 yuan will be reimbursed as 1 ,000 yuan).

3. The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

4. Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

Two, urban medical insurance:

1. Students and children: Medical expenses below RMB 6,543,800+0,800 which are within the scope of reimbursement occur in a settlement year. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

2. At least 70 years old: within a settlement year, medical expenses below 6,543,800 yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

3. Other urban residents: within a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Three, medical insurance for urban and rural residents:

20 16 65438+ 10/2 the State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, demanding that the basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) and the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system) be integrated and a unified basic medical insurance system for urban and rural residents (hereinafter referred to as urban and rural residents' medical insurance) be established. The proportion of medical insurance reimbursement for urban and rural residents in various places shall be subject to the local Measures for the Implementation of Basic Medical Insurance for Urban and Rural Residents.

Fourth, employee medical insurance: Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. You can consult the local social security agency.

legal ground

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.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.