Nanjing social security medical insurance reimbursement ratio

Legal analysis: First, the proportion of reimbursement for general outpatient service. (1) Proportion of reimbursement for residents' general outpatient service. 1. In a natural year, the expenses of "residents" clinics within 200 yuan shall be borne by individuals, 60% of the expenses between 200 and 900 yuan shall be paid in community hospitals and 50% in other hospitals; 2, residents over the age of 80, pay 65% in the community hospital treatment fund, pay 55% in other hospitals, 900 yuan above costs borne by individuals; 3. "Students and children" pay 60% of the medical expenses in the outpatient department of community hospital 0-400 yuan; 4, in other hospitals, the fund pays 50%, and the expenses above 400 yuan are borne by individuals. Second, the proportion of outpatient reimbursement for serious illness. (a) the proportion of serious illness outpatient reimbursement. 1, 50% of the portion from 20,000 yuan to 40,000 yuan; 2, more than 40 thousand yuan to 60 thousand yuan, pay 55%; 3, 60 thousand yuan to 80 thousand yuan, pay 60%; 4, more than 80 thousand yuan to 6.5438 million yuan, pay 65%; 56,5438+70% for the part above 10,000 yuan. 6, "students and children" fund to pay 85%.

(two) the proportion of outpatient serious illness reimbursement. 1, 20,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below), 60%, 40,000 yuan to 60,000 yuan, 65%, 60,000 yuan to 80,000 yuan, 75%, 80,000 yuan to 6,543,800 yuan.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

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

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope: (1) should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) borne by public health; (4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.