Medical insurance is mainly divided into employee medical insurance and resident medical insurance, and the reimbursement ratio is also different. According to the level of hospitalization expenses, the reimbursement rate of medical insurance for employees is between 1300 yuan and 30,000 yuan, accounting for 85%. The reimbursement rate is 90% for 30,000-40,000 yuan, 95% for 4 4- 10/00,000 yuan and 85% for10-300,000 yuan. Residents' medical insurance consists of urban residents' medical insurance and the new rural cooperative medical system. The reimbursement rate is 65% for first-class hospitals and 80% for second-class hospitals. The deductible line of county-level hospital is 400 yuan, the municipal hospital is 600 yuan, and the county-level hospital is 600 yuan.

Employee medical insurance reimbursement

(1), reimbursement rate for outpatient and emergency services (paid by large medical mutual fund) Qifubiaozhun (yuan) reimbursement rate (%) personal burden rate (%) annual limit (ten thousand yuan) 200050502 retirees under 70 years old 13007030270 years old1300800.

(2) The threshold for hospitalization reimbursement (paid by the overall fund) is 30,000 yuan, 30,000 yuan to 40,000 yuan, and 40,000 yuan to 70,000 yuan, and the personal burden reimbursement ratio is 85%15% 90%/kloc-0% 95% 5% secondary hospital 87%13%.

note:

1, the minimum deductible for the first hospitalization each year is 1300 yuan, and the minimum deductible for each hospitalization in the following year is 650 yuan; 360-day settlement period for mental patients with three special diseases; The individual contribution ratio of retirees is 60% of the contribution ratio of on-the-job employees; The maximum annual payment limit of the overall fund is 70,000 yuan.

2. The reimbursement amount is capped at 6,543.8+0.7 million yuan, including 70,000 yuan for basic medical care and 6,543.8+0.8 million yuan for large mutual assistance.

The object of medical insurance for urban residents is the elderly, students, children and unemployed residents.

Outpatient reimbursement: the maximum payment in 650 yuan within one year is 2,000 yuan;

The elderly unemployed residents who exceed the deductible line will be reimbursed 60%, with a maximum reimbursement of 1.5 million;

Students and children who exceed the deductible line will be reimbursed 70%, with a maximum reimbursement of 1.7 million;

The first hospitalization deductible line for the elderly unemployed residents 1300 yuan, the second hospitalization deductible line and the subsequent hospitalization deductible line in 650 yuan; The deductible line for the first and subsequent hospitalization of students and children is 650 yuan.

Reimbursement of rural medical insurance

1, bed fee (the highest is township hospitals 12 yuan/day, and municipal and above medical institutions 15 yuan/day);

2. Drug expenses (the scope of drug use shall be subject to the provisions of the provincial drug catalogue);

3, inspection fees (inspection, testing, etc. , limit 600 yuan);

4. Treatment expenses (settled according to the facts within 300 yuan, and 50% of the above parts in 300 yuan are included in the scope of reimbursement);

5. Surgery fee (charged according to regulations);

6. Blood transfusion fee (operation or rescue, the maximum amount of hospitalization for each time is 500 yuan);

7, material costs (the maximum limit of 2000 yuan per hospitalization);

8, all kinds of tumor patients with radiotherapy, chemotherapy and renal failure need dialysis outpatient expenses, as hospitalization expenses for compensation.

After excluding non-reimbursable expenses, the reportable expenses are discounted according to different levels of medical institutions: township hospitals in this city 100%, municipal hospitals in this city 90%, outside the city 80%, and 60% without referral certificate. After the discount, the expenses will be settled in proportion: 45% will be reimbursed within 4000 yuan; 400 1-8000 yuan will be reimbursed by 55%; 800 1- 12000 yuan will be reimbursed by 65%; 12001-20,000 yuan will be reimbursed by 75%; More than 20 thousand yuan will be reimbursed 80%. The maximum amount of compensation per person per year shall not exceed 30,000 yuan.

Legal basis:

Article 23 of the Social Insurance Law of People's Republic of China (PRC) stipulates that employees shall participate in basic medical insurance for employees, and employers and employees shall pay 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.

Article 26 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the treatment standards of 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.

Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates that 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 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.