Operating expense reimbursement ratio

Within the scope of medical insurance, within one year, the proportion of the insured's hospitalization medical expenses above the threshold and below 60,000 yuan is 6% in the first-class hospital, 8% in the second-class hospital and 10% in the third-class hospital. For retirees and employees who have worked for more than 30 years, the proportion of individual commitment will be halved. 600,000-300,000 yuan shall be borne by 4% of individuals, and some funds above 300,000 yuan shall not be paid.

Legal basis: Article 35 of the Regulations on Basic Medical Insurance for Employees. In a settlement year, the hospitalization medical expenses incurred by the insured in accordance with the scope of medical insurance payment shall be settled according to the following provisions:

(1) One-time hospitalization Qifubiaozhun expenses borne by individuals. For those who have been hospitalized twice or more, the Qifubiaozhun is calculated according to the standards of the highest level medical institutions, specifically: tertiary medical institutions (hereinafter referred to as tertiary medical institutions) in 800 yuan, other medical institutions (including secondary medical institutions) in 500 yuan, and community health service institutions in 300 yuan.

(two) the maximum amount of hospitalization expenses paid by the employee medical insurance fund (based on the date of discharge, hereinafter referred to as the maximum hospitalization limit) is 360 thousand yuan.

(3) The hospitalization medical expenses above the hospitalization Qifubiaozhun and below the maximum hospitalization amount shall be shared by the employee medical insurance pooling fund and individuals. The employee medical insurance fund shall be settled according to the excess progressive system, and the specific proportion is:

1. The minimum threshold for hospitalization is more than 40,000 yuan (inclusive), and the medical expenses incurred in tertiary medical institutions account for 82% of employees and 86% of retirees; For medical expenses incurred in other medical institutions, employees account for 84% and retirees account for 88%; The medical expenses incurred by community health service institutions account for 88% of the employees and 92% of the retirees.

24,000 yuan to 360,000 yuan (inclusive), medical expenses incurred by tertiary medical institutions, 88% of employees and 92% of retirees; Medical expenses incurred in other medical institutions account for 90% of employees and 94% of retirees; The medical expenses incurred by community health service institutions account for 92% of the employees and 96% of the retirees.

(four) medical expenses above the maximum amount of hospitalization in accordance with the provisions of the serious illness insurance shall be borne jointly by the individual and the serious illness insurance fund.