The medical insurance reimbursement limit is the maximum annual amount of reimbursement.

Medical insurance means that through national legislation, basic medical insurance premiums should be paid in full and on time by employers and individual employees in accordance with the principle of compulsory social insurance.

If payment is not made in full and on time, the basic medical insurance pooling fund will not pay for medical expenses, regardless of personal account.

Take the medical insurance payment ratio in Beijing as an example: the employer pays 10% of its total payment base every month, and the employee pays 2% of his salary + 3 yuan for serious illness.

Medical insurance reimbursement limits: Rural areas: 60% of outpatient village clinics and village center clinics are reimbursed, with a limit of RMB 10 for prescription drugs per visit, and a limit of RMB 50 for temporary rehydration prescriptions by doctors at health centers; 40% reimbursement for visits to town health centers, with a limit of RMB 10 for each visit.

The examination fee and operation fee limit per visit is 50 yuan, and the prescription drug fee limit is 100 yuan; the second-level hospital reimburses 30%, the examination fee and operation fee limit per visit is 50 yuan, and the prescription drug fee limit is 200 yuan; tertiary hospital

20% of the medical treatment is reimbursed, with a limit of 50 yuan for each examination and operation fee, and a limit of 200 yuan for prescription drugs; a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice; and an annual limit of 5,000 yuan for town-level cooperative medical outpatient compensation.

Scope of hospitalization reimbursement: medicine expenses: auxiliary examinations: electrocardiogram, X-ray fluoroscopy, radiographs, laboratory tests, physical therapy, acupuncture, CT, MRI and other examination fees, with a limit of 200 yuan; surgery fees (refer to national standards,

If the amount exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

If an elderly person over 60 years old is hospitalized in a health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

Reimbursement ratio: Town health center reimburses 60%; second-level hospitals reimburse 40%; third-level hospitals reimburse 30%.

For serious illness, inpatients who participate in cooperative medical care and whose one-time or annual cumulative medical expenses exceed 5,000 yuan will be compensated in stages, that is, 65% will be compensated for 5,001-10,000 yuan, and 70% will be compensated for 10,001-18,000 yuan.

The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.

Exemptions include medical expenses on your own (without a designated hospital or without a referral form), self-purchased drugs, drugs that cannot be reimbursed under public medical regulations, and medical expenses that do not comply with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, and accompanying guests

expenses, nutrition expenses, blood transfusion expenses (except for those with family blood storage, which shall be reimbursed according to relevant regulations), air conditioning and heating expenses, ambulance expenses, special care expenses and other expenses; medical treatment for car accidents, fights, suicides, alcoholism, work-related accidents and medical accidents

Expenses: Orthopedics, plastic surgery, dentures, prostheses, organ transplants, surgical fees, consultation fees, etc.; within the scope of reimbursement and beyond the limit.

Urban: If urban residents are hospitalized for more than two times in one accounting year, starting from the second hospitalization, the minimum fee will no longer be charged.

If you are transferred to another hospital or hospitalized for two or more times, the difference will be made up according to the prescribed minimum payment standard for transfer or readmission to the hospital.

If students or children incur medical expenses of less than 180,000 yuan within the reimbursement range within a accounting year, the minimum payment standard for third-level hospitals is 650 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; the minimum payment standard for second-level hospitals is 300 yuan

, the reimbursement ratio is 60%; first-level hospitals do not set minimum payment standards, and the reimbursement ratio is 65%.

If you are 70 years old or above and incur medical expenses of less than 100,000 yuan within the reimbursement range within a accounting year, the minimum payment standard for third-level hospitals is 650 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; the minimum payment standard for second-level hospitals

The reimbursement rate is 300 yuan, and the reimbursement rate is 60%; there is no minimum payment standard for first-level hospitals, and the reimbursement rate is 65%.

For other urban residents who incur medical expenses of less than 100,000 yuan within the scope of reimbursement within a accounting year, the minimum payment standard for third-level hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; the minimum payment standard for hospitalization in second-level hospitals is 300 yuan

Yuan, the reimbursement rate is 55%; there is no minimum payment standard for first-level hospitals, and the reimbursement rate is 60%.

Employees: Generally speaking, the economic development situation in different regions is different, so the reimbursement ratios are also different. The following is an explanation of the insurance ratio of Beijing employee medical insurance.

After enrolling in medical insurance, if you are an active employee, you can only reimburse for medical expenses exceeding 1,800 yuan after going to the hospital's outpatient clinic or emergency room, and the reimbursement rate is 50%.

For retirees under the age of 70, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%.

For retirees over 70 years old, 80% of expenses above 1,300 yuan can be reimbursed.

Regardless of the type of person, the maximum amount for outpatient and emergency medical expenses is 20,000 yuan.

For example, if you are an active employee and the cost of outpatient treatment is 2,500 yuan, then 50% of the 500 yuan can be reimbursed, which is 250 yuan.

If it is hospitalization expenses, when the basic medical insurance is used for payment for the first time in 2009, the minimum payment amount is 1,300 yuan for both working people and retirees.