Proportion of reimbursement for medical treatment with Ningbo social security card

Legal analysis: (1) Outpatient medical services are divided into three categories: community health service institutions (including township hospitals, the same below), tertiary medical institutions and other medical institutions. Adult residents set different payment ratios and maximum payment limits of medical insurance funds for file A and file B according to insurance types, and infants and students enjoy outpatient medical treatment according to the standard of file A for adult residents.

(two) the outpatient medical treatment of urban insured persons is divided into the following two standards:

File 1. A: 60% of the medical expenses incurred in community health service institutions are paid by the medical insurance fund, and the rest are borne by individuals; For medical expenses incurred in tertiary medical institutions and other medical institutions, the proportion of medical insurance fund payment is 30% and 45% respectively, and the rest is borne by individuals; The maximum payment limit of outpatient medical expenses is 4000 yuan.

2. File B: 50% of the medical expenses incurred in community health service institutions shall be paid by the medical insurance fund, and the rest shall be borne by individuals; For medical expenses incurred in tertiary medical institutions and other medical institutions, the proportion of medical insurance fund payment is 20% and 35% respectively, and the rest is borne by individuals; The maximum payment limit of outpatient medical expenses is 3000 yuan.

Legal basis: Article 2 of People's Republic of China (PRC) Social Insurance Law The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance. To ensure citizens' right to receive material assistance from the state and society in accordance with the law in cases of old age, illness, work injury, unemployment and maternity.