How much can the social security card be reimbursed for medical treatment?

Social security card reimbursement is generally proportional to reimbursement.

Proportion of hospitalization reimbursement

1. 90% can be reimbursed for the part of the first-class hospital that exceeds the Qifubiaozhun to the maximum payment limit;

2. For secondary hospitals, 85% can be compensated for the part above the minimum threshold of 1 0,000 yuan; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%;

3 tertiary hospitals, more than Qifubiaozhun to 5000 yuan, can compensate 80%; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

4 retirees can increase 5% on the basis of the above reimbursement ratio.

The basic medical insurance fund is not responsible for the following medical expenses:

Injuries caused by traffic accidents, medical accidents or other accidents; Buying drugs at non-designated retail pharmacies; If you don't go to the designated hospital of your choice for medical treatment, the emergency situation will not be covered; Injury caused by taking drugs, fighting or other illegal acts; Treatment expenses due to suicide, self-mutilation, alcoholism and other reasons; The expenses for medical treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province shall be borne by the insured.

The medical expenses incurred by enterprise employees due to work-related injuries and occupational diseases shall be implemented in accordance with the relevant provisions of work-related injury insurance. Medical expenses incurred by female workers during their maternity shall be reimbursed in accordance with relevant policies and regulations.

Matters needing attention for hospitalization reimbursement of social security card:

1, different hospitals have different reimbursement rates for medical insurance. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not medical insurance and cannot be reimbursed.

2. If you have paid your own medical expenses, how can you go through the social security process? There are two situations in which medical expenses are paid first and then reimbursed by medical insurance: first, they can be reimbursed by bills; Second, the hospital directly settled with social security. Either way, reimbursement should be made according to the corresponding specified time and information. 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.

legal ground

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

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.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(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.