Kunshan medical insurance reimbursement ratio

Legal analysis: in the settlement year, after the expenses incurred by the insured for each hospitalization are calculated according to the regulations, the rest will directly enter the settlement part of the corresponding medical insurance fund according to the actual accumulated expenses of the specific items of hospitalization and outpatient service in that year: the part below 40,000 yuan will be settled according to the proportion of 90% of employees and 95% of retirees; The part exceeding 40,000 yuan shall be settled by 95%.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), 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.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.