How much can employee medical insurance be reimbursed at most?

Employees' medical insurance can generally be reimbursed up to 95%.

The proportion of medical insurance reimbursement for employees is divided according to the actual medical expenses incurred by the insured. Usually, the minimum reimbursement rate for hospitalization is 85%, and the maximum reimbursement rate is 95%. In primary medical and health institutions, 80% is paid before retirement and 90% after retirement; In other designated medical institutions, 70% will be paid before retirement and 80% after retirement.

Conditions for reimbursement of employee's serious illness medical insurance:

1. Medical insurance type: Employee's serious illness medical insurance refers to the medical insurance type consisting of employee's basic medical insurance and serious illness insurance, so the applicant needs to confirm whether it meets the relevant medical insurance conditions;

2. Scope of disease: Medical insurance for employees with serious illness is usually only for specific disease scope, such as malignant tumor, pneumoconiosis, hepatitis, etc. Applicants need to determine whether their illness is within the scope of reimbursement;

3. Reimbursement ratio: The reimbursement ratio of employee's serious illness medical insurance is different from that of ordinary medical insurance, which is generally higher, but the applicant needs to know the specific reimbursement ratio and reimbursement upper limit;

4. Reimbursement time: The employee's serious illness medical insurance stipulates the time limit for reimbursement, and the applicant needs to apply for reimbursement within the specified time, otherwise the reimbursement effect may be affected;

5. Medical expenses: The medical insurance for employees with serious illness reimburses the medical expenses that meet the policy requirements. Applicants need to know the medical expenses they need to pay and apply for reimbursement according to the prescribed procedures.

To sum up, the reimbursement process of employees' serious illness medical insurance in different regions and units may be different, and the specific process shall be subject to the provisions of local social security agencies. In order to facilitate future use, medical insurance should be paid in time.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.