Proportion of social security hospitalization reimbursement in Guangzhou

When the medical expenses of employees and retirees for hospitalization, outpatient emergency rescue or outpatient treatment of some serious and serious diseases exceed the "top line" of the overall fund within an insurance year, the commercial insurance company will be responsible for the claims according to the method of subsection calculation and cumulative compensation, but individuals will also bear a certain proportion of the expenses, specifically: (! ) 30,000 yuan to 654.38+10,000 yuan (inclusive) of medical expenses, 94% of the large medical insurance premium is paid, and 6% is paid by the individual; (2) For medical expenses ranging from 6,543,800 yuan to 200,000 yuan (inclusive), 96% of the large medical insurance premium is paid, and 4% is paid by the individual; (3) For medical expenses of more than 200,000 yuan, 98% is paid for large medical insurance premiums, and 2% is paid for individuals. In a year, the highest proportion of large medical insurance premiums is 300,000 yuan per person.

Legal objectivity:

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

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Social insurance law

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

Article 28

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.

Social insurance law

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.