1, students, children. In a settlement year, medical expenses that meet the scope of reimbursement occur:

(1) The reimbursement rate of tertiary hospitals is 55%;

(2) The reimbursement rate of secondary hospitals is 60%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 65%;

2. Older people over 70 years old. In a settlement year, medical expenses that meet the scope of reimbursement occur:

(1) The reimbursement rate of tertiary hospitals is 50%;

(2) The reimbursement rate of secondary hospitals is 60%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 65%;

3. Other urban residents. In a settlement year, medical expenses that meet the scope of reimbursement occur:

(1) The reimbursement rate of tertiary hospitals is 50%;

(2) The reimbursement rate for hospitalization in secondary hospitals is 55%;

(3) There is no Qifubiaozhun for the first-level hospitals, and the reimbursement rate is 60%.

The medical insurance reimbursement process is as follows:

1. When the applicant submits the application materials, the accepting department shall review the application materials within 5 days from the date of receiving the application materials and decide whether to accept them;

2. If the application materials are incomplete, inform the applicant of all the contents that need to be corrected at one time within the above 5 days;

3. The applicant shall make corrections within 5 days from the date of receiving the notice of correction of materials;

4, overdue correction, as the withdrawal of the application;

5. However, after the materials are corrected, the applicant may reapply within the statutory validity period;

6. After the Social Insurance Fund Administration has reviewed the materials and approved the application, the applicant will receive the reimbursement form for medical expenses of social medical insurance and be reimbursed.

The materials required for medical insurance reimbursement are as follows:

1, copy of ID card and medical insurance card;

2. A copy of the savings card or passbook of China Bank;

3, invoices (medical settlement documents reimbursement vouchers), medical expenses detailed summary list;

4. Copy of hospitalization medical records (including: medical record home page, admission records, long-term doctor's orders, temporary doctor's orders, discharge records or discharge summaries, main inspection results and operation records);

5. Discharge certificate;

6. When the accidental injury is reimbursed for hospitalization, it is necessary to provide the injury process certificate issued by the public security organ or the neighborhood committee of the injured place.

In summary, the reimbursement rate of residents' medical insurance is basically 50%. Different people and hospitals have different reimbursement rates.

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.