The proportion of medical insurance reimbursement for subsistence allowances is generally 84%. China's medical insurance reimbursement for rural subsistence allowances is "medical insurance reimbursement first, then national assistance", that is, the medical expenses that meet the medical insurance reimbursement are reimbursed 60% at the time of settlement. The rest can also apply for medical assistance after settlement, and then reimburse 60%.
The reimbursement ratio of medical insurance for retirees is as follows:
Before the founding of the People's Republic of China, retired cadres, retired workers, disabled people in the line of duty, third-stage silicosis patients and second-class disabled soldiers were hospitalized due to illness, and their medical and drug expenses were reimbursed 100%.
Retired workers have worked for more than 30 years, and 90% of medical expenses are reimbursed.
Retired employees with working experience of 2 1 to less than 30 years will be reimbursed 85% of medical expenses.
Retired employees with working years 15 to 2 1 year or less will be reimbursed 80% of medical expenses.
Low-income and low-income groups intend to be reimbursed according to the medical insurance types they participate in according to the principle of "insurance first, then assistance", and the rest can apply for medical assistance, that is, 60% reimbursement. Most of these people participated in the "one old" or unemployed residents' medical insurance, and the original hospitalization reimbursement amount was 60%; So these people are reimbursed 84%.
In addition, the outpatient expenses of three cases can be calculated according to the hospitalization expenses: the outpatient medical expenses of taking anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, renal dialysis and kidney transplantation (including combined liver and kidney transplantation); Emergency observation and hospitalization, medical expenses incurred within 7 days before hospitalization; To observe the medical expenses of emergency rescue patients who died within 7 days before their death.
For example, Mr. Wang, a low-income person and unemployed urban resident, spent 6,543,800 yuan on hospitalization. Because it is a low-income person, there is no deductible for hospitalization reimbursement. According to the medical insurance policy for unemployed residents he participated in, the reimbursement rate for hospitalization is 60%, and he can first reimburse 6,000 yuan with medical insurance. You can apply for temporary medical assistance for the out-of-pocket part of 4000 yuan, and then reimburse 60%, that is, 2400 yuan. To sum up, the medical expenses of Mr. Wang 1000 yuan can be reimbursed for 8400 yuan.
Legal basis:
People's Republic of China (PRC) social insurance law
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;
(3) Going abroad for medical treatment that should be borne by public medical care.
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.
People's Republic of China (PRC) social insurance law
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
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.