1. Outpatient medical expenses:
Urban and rural residents medical insurance insured in outpatient medical institutions (generally township hospitals, community health service centers) in line with the outpatient medical expenses within the scope of outpatient co-ordination payment, outpatient co-ordination fund can be reimbursed 60%, a maximum reimbursement of 200 within the validity period of insurance;
2. College students' outpatient medical expenses:
College students can be reimbursed 60% of the first outpatient expenses in medical institutions (usually school hospitals), and the maximum reimbursement can be 500 within the validity period of an insurance. The outpatient medical expenses incurred by college students due to trauma belong to the basic medical insurance coverage, and 90% can be reimbursed if they are over 50, and 800% can be reimbursed if an insurance is valid.
3. For hospitalization expenses:
(1) reimbursement of basic medical insurance for urban and rural residents: for students and children hospitalized in community hospitals, 95% of the basic medical insurance for urban and rural residents can be reimbursed, with the deductible line of100; In the first-class hospital, the basic medical insurance for urban and rural residents can be reimbursed 85%, with the deductible line100; For those hospitalized in secondary hospitals, 75% of the basic medical insurance for urban and rural residents can be reimbursed, and the deductible is 200; For those hospitalized in tertiary hospitals, 60% of the basic medical insurance for urban and rural residents can be reimbursed, and the deductible is 500. The capping line is 6 times of the disposable income of urban households in the previous year;
(2) Reimbursement of serious illness insurance for urban and rural residents: the deductible line is 50% of the per capita disposable income of urban and rural residents in the previous year (the poor population can be reduced by 50% on this basis), and there is no capping line. The part below 5000 can be reimbursed 60%, the part between 5000 and 20000 can be reimbursed 85%, the part between 20000 and 50000 can be reimbursed 90%, and the part above 50000 can be reimbursed 96%. However, the reimbursement rate of poor people below 50,000 can be increased by 5% respectively on the above basis;
(3) Reimbursement of supplementary insurance for serious illness medical assistance: the deductible line is consistent with the basic medical insurance for urban and rural residents, with a cap line of 400,000. 77% below 10000, 80% below 10000-30000, 85% between 30000 and 50000, and 90% above 50000.
legal ground
People's Republic of China (PRC) Social Insurance Law Article 2 The State establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance. To ensure citizens' right to get material help from the state and society in accordance with the law in case of old age, illness, work injury, unemployment and maternity.
Article 24 The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.