Kunshan employee health insurance reimbursement ratio

Legal analysis: after the health insurance, if you are an active employee, after visiting the outpatient and emergency clinic of the hospital, only the medical expenses of more than 2,000 yuan can be reimbursed, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, expenses over $1,300 can be reimbursed the reimbursement rate is 80%. And no matter which category you are in, the maximum amount of expenses paid for outpatient and emergency major medical expenses is $20,000 dollars. For example, if you are an active employee and you spend $2,500 on an outpatient visit, you can be reimbursed 50 percent of the $500 portion, which is $250.

Legal basis: The Social Insurance Law of the People's Republic of China Article 30 The following medical expenses shall not be included in the scope of payment of the basic medical insurance fund:

(1) Those that should be paid from the Workers' Compensation Insurance Fund (2) Those that should be borne by a third party (3) Those that should be borne by the public ****health (4) Those that are sought outside the country.

Medical expenses shall be borne by the third party according to law, the third party does not pay or cannot determine the third party, the basic medical insurance fund to pay first. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.