The specific reimbursement ratio depends on the level of medical insurance expenses purchased, specifically the actual hospitalization expenses. If the hospitalization expenses of employees are between 1.300 yuan and 30,000 yuan, the reimbursement ratio is 85%; If the employee's hospitalization expenses are between 30,000 yuan and 40,000 yuan, the reimbursement ratio is 90%.

It can be seen that the factors that affect the reimbursement ratio also include the cost of treatment in the hospital. 50% to 95% "The parties can generally reimburse 50% to 95% for using the medical insurance card. The proportion of medical insurance reimbursement for employees is divided according to the actual medical expenses incurred by the insured. Usually, the minimum reimbursement rate for hospitalization is 85%, and the maximum reimbursement rate is 95%. The proportion of medical insurance reimbursement for urban and rural residents is between 50% and 80% according to the hospital level.

Due to the different economic levels in different regions, the proportion of medical reimbursement may be slightly different. "Medical insurance card reimbursement is generally proportional, generally 60%-70%. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur. The threshold for tertiary hospitals is RMB 659, and the reimbursement ratio is 50%, with an upper limit of RMB 2,000. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Medical insurance reimbursement conditions

1, normal insurance payment (indicating the insurance payment status at the time of hospitalization) and the treatment review expires (unit insurance payment is 30 days, and individual insurance payment is 6 months).

2, the disease in accordance with the "basic medical insurance inpatient disease directory".

3. The information is complete. To sum up, medical insurance is the basic social insurance for employees. Under normal payment conditions, employees can be reimbursed as long as the materials are complete. Among them, the reimbursement rate of hospitalization expenses is about 85%, and individuals only need to bear a small part.

When employees reimburse medical insurance expenses, they should bring relevant materials and provide complete information as far as possible. The medical insurance system currently established in China is relatively perfect.

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;

(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.