The proportion of medical insurance reimbursement for retirees shall be formulated by the local medical insurance bureau or social security center according to the policy and published in the medical insurance handbook. Generally speaking, for ordinary medical expenses, such as outpatient service, hospitalization, medicines, etc. The proportion of medical insurance reimbursement ranges from 60% to 80%, and the rest is borne by individuals themselves. The reimbursement amount is paid by the medical insurance fund. For special diseases and major diseases, the proportion of medical insurance reimbursement can reach more than 90%. For example, for malignant tumors, anemia and other diseases, the proportion of medical insurance reimbursement is generally between 85% and 95%, and the reimbursement amount will vary according to the different treatment costs. Some areas will also give a certain degree of follow-up subsidies to help retirees ease their economic pressure. It should be noted that retirees must go to the designated hospital for medical insurance when enjoying the medical insurance service for employees. Otherwise, the cost of treatment in non-medical insurance designated hospitals cannot be reimbursed through employee medical insurance accounts.
How much does the retiree's medical insurance personal account need to pay? Retirees' separate payment of medical insurance personal account fees has stopped, but is paid by the community or unit where the individual belongs. Therefore, retirees do not need to pay the medical insurance personal account fee separately, but only need to be reimbursed according to the regulations when enjoying the employee medical insurance service.
The proportion of medical insurance reimbursement for retirees is 60% to 80%, and the proportion of medical insurance reimbursement for special diseases and major diseases can reach more than 90%. Retirees need to see a doctor in a designated medical insurance hospital, otherwise they will not be reimbursed. Retirees do not need to pay the medical insurance personal account fee separately, but only by their community or unit.
Legal basis:
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.
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.