Reimbursement ratio of employee medical insurance community hospitals

First, the reimbursement rate of employees' social security hospitalization is 1, and the first-level hospital pays 90% of the part above the Qifubiaozhun to the highest payment limit; 2, secondary hospitals, Qifubiaozhun to 10000 yuan (inclusive) to pay 85%, more than 10000 yuan to pay 90%; 3, tertiary hospitals, Qifubiaozhun to 5000 yuan (inclusive) of the part by 80%, 5000 yuan to 1 ten thousand yuan of the part by 85%, 1 ten thousand yuan of the highest payment limit by 90%; 4. Retirees will increase by 5% on the basis of the above payment ratio. Second, the reimbursement scope of employee medical insurance hospitalization is 1, and the expenses incurred during the period when the new insured did not issue a 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.

Legal objectivity:

"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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. Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.