1, urban residents:

(1) The proportion of medical expenses within the scope of overall payment above Qifubiaozhun is 50% for the residents of the first-class hospital;

(2) 60% of secondary hospitals;

(3) 70% of tertiary hospitals;

Qifubiaozhun for the second and above hospitalization within one year is calculated according to 75% of the stipulated Qifubiaozhun for hospitalization;

2, urban workers:

(1) 30% of employees and 27% of retirees;

(2) For those hospitalized for many times within one year, the minimum deductible and personal burden ratio shall be set for each time, and the second minimum deductible ratio shall be 10%, and the personal burden shall be 28%;

(3) The minimum deductible for three times or more is 8%, and the personal burden is 26%;

(4) The minimum payment for retirees is the same as that for on-the-job employees, and the personal burden ratio is 27%, 25% and 23% respectively.

There is a difference between hospitals at different levels and hospitals transferred to other provinces and cities. Grade III and above increase by 1 percentage point, and grade I decrease by 1 percentage point.

Check the proportion of medical insurance reimbursement:

1. Local inquiry: Insured persons can directly bring their ID cards and residents' medical insurance cards to the service hall of the local social security bureau to print the payment list, and can inquire about relevant information in detail. This way is more direct and suitable for people who can't help themselves by phone and have time.

2. Telephone inquiry: The insured can directly call the Social Security Bureau at telephone number 12333 for inquiry. Follow the voice prompts and enter the social security card number. This query method is also convenient and fast, and it is the first choice of many people;

To sum up, the three most commonly used types of medical insurance reimbursement are general drug purchase, outpatient service and hospitalization. Different categories have different reimbursement rates, methods and procedures.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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

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.