Proportion of reimbursement for hospitalization expenses of medical insurance

50% to 95% "The parties can generally reimburse 50% to 95% for using the medical insurance card. 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%. The proportion of medical insurance reimbursement for urban and rural residents is between 50% and 80% according to the hospital level. Due to the different economic levels in different regions, the proportion of medical reimbursement may be slightly different. " Medical insurance card reimbursement is generally proportional,

50% to 95% is generally reimbursed 60%-70%. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur. The threshold for tertiary hospitals is RMB 659, and the reimbursement ratio is 50%, with an upper limit of RMB 2,000. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

The hospitalization reimbursement standard is related to the hospital level where the insured lives:

1. If you live in a tertiary hospital, the employee pays 15%, that is, 85% is reimbursed, and the minimum threshold is 30,000 yuan.

Expenses ranging from 23,000 yuan to 40,000 yuan are paid by employees themselves 10% and reimbursed by 90%.

3, more than 40000 yuan to the maximum payment limit, 95% can be reimbursed, employees only need to pay 5%.

4, and the individual contribution ratio of retirees is 60% of the on-the-job (that is, the above-mentioned) employees, but below the minimum threshold, they are all paid by individuals.

Medical insurance reimbursement conditions

1, normal insurance payment (indicating the insurance payment status at the time of hospitalization) and the treatment review expires (unit insurance payment is 30 days, and individual insurance payment is 6 months).

2, the disease in accordance with the "basic medical insurance inpatient disease directory".

3. The information is complete.

To sum up, medical insurance is the basic social insurance for employees. Under normal payment conditions, employees can be reimbursed as long as the materials are complete. Among them, the reimbursement rate of hospitalization expenses is about 85%, and individuals only need to bear a small part. When employees reimburse medical insurance expenses, they should bring relevant materials and provide complete information as far as possible. The medical insurance system currently established in China is relatively perfect.

Legal basis:

Article 28 of the Social Insurance Law

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.