Social security reimbursement calculation formula

The calculation formula of medical insurance reimbursement ratio is: (total expenses-expenses below deductible line-self-funded items) * reimbursement ratio.

The proportion of medical insurance reimbursement is as follows:

1. If you are an on-the-job employee, you can only reimburse more than 2,000 yuan for medical expenses after seeing a doctor in the emergency department of the hospital, and the reimbursement rate is 50%.

For retirees under the age of 2.70, the expenses above 65,438 yuan +0.300 yuan can be reimbursed, and the reimbursement ratio is 70%.

3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed.

4. Hospitalization expenses. When the basic medical insurance was used for the first time in 2009, the minimum payment for employees and retirees was 1.300 yuan. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan.

5. The annual maximum payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan. The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, if you live in a tertiary hospital, the employee pays 15%, that is, 85% is reimbursed, from the minimum payment standard to 30,000 yuan.

Legal basis:

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.