Proportion of second-class reimbursement of medical insurance

The proportion of second-class reimbursement for medical insurance and second-class reimbursement for hospitalization for social security varies from region to region. For example, Shenzhen II social security hospitalization reimbursement ratio:

The reimbursement rate of the second-class social security in Shenzhen is about 70%-80%, and the outpatient service can be reimbursed 1000 yuan per year. You can't use your card when social security stops. If the interruption exceeds 3 months, the payment period will be recalculated. This card can only be used in the next month after the social security is successfully deducted. The reimbursement rate of Kunshan medical insurance clinic is 50%-80%, with a maximum of 20,000 yuan. The reimbursement rate of urban residents' medical insurance outpatient service is 60%, and the treatment of special diseases is the same as that of ordinary hospitalization. The reimbursement rate for urban workers' medical insurance outpatient service is 50%-80%, and the exemption amount for special disease outpatient service is 400 yuan. The reimbursement rate for outpatient service of the new rural cooperative medical system is 30%-60%, and the exemption amount for outpatient service of special diseases is 400 yuan.

Medical insurance reimbursement methods are as follows:

1. Before seeing a doctor: Before seeing a doctor, you need to confirm the type and scope of your medical insurance, choose medical institutions and doctors that meet the medical insurance policy, and ensure that medical expenses can be reimbursed;

2. During medical treatment: during medical treatment, you need to fill in your basic personal information and medical conditions accurately, and provide your medical insurance card and related certification materials to doctors and medical institutions;

3. Reimbursement application: After seeing a doctor, you need to submit an application for reimbursement of medical expenses to the local social insurance management center or medical insurance office, and provide relevant medical expenses bills and supporting materials, such as outpatient invoices, prescription notes, medical records, etc.

4. Reimbursement review: medical insurance institutions review the application for reimbursement of medical expenses, check the information such as expenses and illness, and determine the proportion and amount of reimbursement;

5. Reimbursement payment: After approval, the medical insurance institution will pay the reimbursement amount to the applicant's bank account or medical insurance card.

To sum up, the second-class reimbursement ratio adjustment scheme of medical insurance refers to the scheme of adjusting the second-class reimbursement ratio in the current medical insurance system.

Legal basis:

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

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.