Hefei medical insurance reimbursement ratio 2023

The Hefei health insurance reimbursement rates for 2023 are as follows:

1. The hospitalization reimbursement rate for employee health insurance:

(1) 85% for hospitalization fees between 1300 yuan and 30,000 yuan;

(2) 90% for reimbursement between 30,000 yuan and 40,000 yuan;

(3) 95% for reimbursement between 40,000 yuan and 100,000 yuan;

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(4) 85% for reimbursement between 100,000 yuan and 300,000 yuan;

2. Reimbursement rate for residents' health insurance:

(1) 65% for reimbursement for first-class hospitals;

(2) 80% for reimbursement for second-class hospitals over 6,000 yuan.

Methods for checking the reimbursement rate of medical insurance:

1. Local inquiry

Participants can directly bring their ID cards and resident medical insurance cards to the local social security bureau service hall to print the list of contributions, which can be used to check the relevant information in detail. This method is more direct, suitable for people who do not know how to access the Internet, do not know how to use telephone self-service and have time, and is more suitable for elderly people of a certain age;

2, telephone inquiry

Participants can directly call the Social Security Administration telephone number 12333 to make inquiries. Follow the voice prompts to operate, you need to enter the social security card number as well as the account password. This kind of inquiry is also more convenient and fast, is the first choice of many people;

3, online inquiry

Online inquiry is suitable for people who know how to operate the computer, and do not have much leisure time to operate. First find the local social security bureau online, open the web page, enter your personal social security card account number, query password and ID number and other personal information, you can query to their latest account information, convenient and fast.

In summary, the three most common types of reimbursement for medical insurance are general purchases of medicines, outpatient care and hospitalization, and the reimbursement rates, methods, processes and other considerations are different for each category.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in accordance with the basic medical insurance catalog of medicines, diagnostic and therapeutic items, standards of medical service facilities, and those for emergency and rescue shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.