How to reimburse large medical insurance? Introduction of reimbursement ratio and process

Legal analysis: reimbursement ratio: 1. For outpatient and emergency medical expenses exceeding 2,000 yuan within one year, 50% will be paid by mutual fund for large medical expenses and 50% by individuals. 2. For retirees whose outpatient and emergency medical expenses exceed 1300 yuan in a year, 70% will be paid by the mutual fund for large medical expenses and 30% will be paid by the individual; For retirees over 70 years old, 80% of the large medical expenses are paid by mutual funds and 20% by individuals. 3 workers and retirees outpatient and emergency medical expenses within a year of large medical expenses mutual fund maximum payment limit of 20000 yuan. 4. Employees and retirees exceed the maximum payment limit of the basic medical insurance pooling fund (excluding the following Qifubiaozhun and personal burden) for hospitalization medical expenses, outpatient medical expenses for taking anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, renal dialysis and kidney transplantation, and 70% for mutual funds for large medical expenses and 30% for individuals. However, the maximum amount of medical expenses paid by mutual funds in one year is 654.38+10,000 yuan.

Reimbursement process: 1. In case of network failure, loss of social security card, degaussing and card suspension, the insured shall pay the outpatient medical expenses in full. 2, the insured unit is responsible for the collection, paste, fill in the report and summary (fill in the medical No.9, No.8 handover form), stamped with the official seal of the unit, and declare to the social security sub-center where the insured person is located. Municipal civil servants medical expenses reported to the medical insurance settlement center; The medical expenses of AIDS patients are reported to the infectious disease hospital.

Legal basis: Article 25 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the state shall establish and improve the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.