1, reimbursement scope. The hospitalization expenses incurred by the insured in the designated medical insurance hospital or the specialist hospital, Chinese medicine hospital and 3A hospital selected by the individual;

2. Reimbursement ratio. Qifubiaozhun is 1300 yuan for the first hospitalization in a natural year, and 650 yuan for each subsequent hospitalization. The payment ratio is divided into three grades. Take a tertiary hospital as an example, the floating standard is 30,000 yuan, with 85% of employees, 9 1% of retirees, 90% of employees and 94% of retirees.

First, the conditions for reimbursement of medical insurance for urban workers are as follows:

1, outpatient and emergency medical expenses. During the year, the medical expenses of on-the-job employees who meet the basic medical insurance coverage totaled more than 2,000 yuan;

2. Settlement ratio. During the contract period, 50% of the dispatched personnel will be reimbursed for more than 2,000 yuan, and 50% will be paid by the individual. The maximum reimbursement for outpatient and emergency services paid by dispatched personnel within one year is 20,000 yuan;

3. Reimbursement voucher. The insured shall properly keep the outpatient medical documents of designated hospitals, including the receipts and prescriptions of the following parts, as medical expense reimbursement vouchers;

4. Outpatient treatment of three special diseases. When the insured suffers from malignant tumor radiotherapy and chemotherapy, renal dialysis, kidney transplantation, etc. and needs to take anti-rejection drugs in the outpatient department, the second-and third-level designated hospitals where the insured goes to see a doctor shall issue a disease diagnosis certificate, fill in the medical insurance special disease declaration and approval form, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement;

5. Hospitalization. After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.

Two, the legal provisions of medical insurance payment are as follows:

1, employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations;

2, to participate in the basic medical insurance for employees, to reach the statutory retirement age, the cumulative payment reached the number of years prescribed by the state, no longer pay the basic medical insurance premium after retirement, and enjoy the basic medical insurance benefits in accordance with state regulations. If the fixed number of years stipulated by the state is not reached, it can be paid to the fixed number of years stipulated by the state;

3, in line with the basic medical insurance drug list, diagnosis and treatment projects, medical service facilities standards and emergency, rescue medical expenses, in accordance with state regulations, paid from the basic medical insurance fund.

In short, the scope and proportion of medical insurance reimbursement for employees are stipulated by law. Medical insurance reimbursement for urban workers needs to meet their reimbursement conditions, and medical insurance payment has perfect legal provisions. 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.

People's Republic of China (PRC) social insurance law

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.

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.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be 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.