The amount of medical insurance reimbursement in five insurances and one gold depends on many factors, including the age of the insured, the payment base, medical expenses and so on. Generally speaking, the proportion of medical insurance reimbursement is between 50% and 95%, and the specific proportion depends on the age of the insured and the medical expenses.

1. Specifically, if the insured person is a retiree aged 70 or above, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement will occur within one settlement year, and the threshold for tertiary hospitals is 650 yuan, with the reimbursement ratio of 50% and the upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

2 other urban residents, in a settlement year, the occurrence of medical expenses in line with the scope of reimbursement of 65438+ million yuan. The threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; 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%.

What are the reimbursement scopes of social security?

The scope of reimbursement for social security and medical insurance is as follows: outpatient and emergency medical expenses; The cost of purchasing drugs at designated retail pharmacies; Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund; Medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion. Drug expenses that meet the basic medical insurance drug list; Treatment expenses that meet the diagnosis and treatment items; Medical expenses that meet the standards of medical service facilities; And the medical expenses of the insured for emergency treatment and rescue.

The specific conditions and scope vary according to regional policies and insurance types. Generally speaking, the reimbursement conditions include: 1, who has participated in social security and paid the corresponding fees; 2. The reimbursement items must be within the scope of social security; 3. Need relevant certificates and materials.

To sum up: the proportion of medical insurance is graded according to different situations. Taking into account the differences between workers and peasants, age differences, category differences and so on. Therefore, when people are hospitalized or seeing a doctor, especially when the medical expenses are high, it is recommended to go to a hospital that meets the requirements.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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.