The standards for the overall reimbursement ratio of medical insurance in 2023 are as follows: the general outpatient payment ratio for active employees is 70% for first-level medical institutions including township hospitals and community health service centers, 60% for second-level medical institutions, and 45% for third-level medical institutions. The payment ratio for retirees is

It will be increased by 5% according to the level of medical institutions; the minimum payment limit for Xi'an employees' medical insurance outpatient services is 200 yuan; the maximum annual payment limit for ordinary outpatient services for current employees is 2,000 yuan, and the maximum payment limit for retirees is 2,500 yuan.

The annual maximum payment limit is valid for the current year and does not roll over or accumulate.

The overall reimbursement procedure is as follows: 1. The insured employee must present his or her citizen card and swipe the card for outpatient treatment. The outpatient clinic must inform the hospital of the type of medical treatment. If the card is not produced or the type of medical treatment is not clearly informed, the insured employee shall be responsible for the medical treatment that occurred when the insured employee sought medical treatment.

The cost will not be paid by the medical insurance fund; 2. When purchasing medicines at designated retail pharmacies, insured persons must show their citizen card, inform the type of treatment, and swipe the card to purchase medicines according to relevant requirements. When others purchase medicines on their behalf due to special circumstances, they must show their insured

The ID card of the employee and the purchaser shall be registered and filed by the pharmacy; 3. When the insured person of the employee medical insurance visits the outpatient clinic, the medicines, examinations, tests, consumables, etc. within the scope of the policy within the scope of the medical insurance reimbursement catalog that occur within a natural year

For outpatient medical expenses, the standard threshold fee for tertiary hospitals is 300 yuan in total and will be reimbursed at a rate of 60%.

Medical insurance reimbursement ratio: The medical insurance reimbursement ratio is determined based on local policies and regulations, and the reimbursement ratio may differ in different regions.

Generally speaking, the reimbursement ratio of medical insurance includes two aspects: 1. Basic medical insurance payment ratio: The basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, generally ranging from 70% to 80%; 2. Personal out-of-pocket ratio

: The personal out-of-pocket ratio refers to the proportion of medical expenses that an individual needs to bear, generally ranging from 20% to 30%.

Medical insurance reimbursement process: 1. Confirm the scope of reimbursement: During the treatment process, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement; 2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists, etc.

Materials; 3. Go to the social security department for reimbursement: submit relevant materials to the local social security department and go through the medical insurance reimbursement procedures; 4. Wait for review: the social security department will conduct relevant reviews and comparisons to confirm the reimbursement ratio and amount; receive the reimbursement money

: After passing the review, you can receive medical insurance reimbursement at the designated bank.

To sum up, the reimbursement ratios of medical insurance in various regions are different. Urban and rural residents who have lived in other places for a long time, urban and rural residents who are men over 60 years old and women over 55 years old, urban and rural residents who are working in other places, and students and children who live with them,

For those who have registered for medical treatment in other places, the deductible standard for hospitalization in the place of registration and registration is 400 yuan for first-level hospitals, 800 yuan for second-level hospitals, and 2,000 yuan for third-level hospitals. The reimbursement ratio follows the reimbursement ratio of local designated hospitals.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" that meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be deducted from the basic medical insurance fund in accordance with national regulations.

Pay.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.

The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.