1. Reimbursement rate of urban residents: first-class hospitals: 85%; Secondary hospitals: 70%; Tertiary hospitals: 60%; Emergency hospitalization: 50%; Referral from tertiary hospitals in different places: 55%. Proportion of reimbursement for general outpatient service: medical expenses above Qifubiaozhun that meet the scope of outpatient co-ordination payment, and the proportion of outpatient co-ordination fund payment is 50%.

2. Reimbursement ratio of urban workers: within 5,000 yuan (including 5,000 yuan), individuals pay for the first-level medical version 15%, second-level hospitals 17%, and third-level hospitals19%; 5000 yuan to 15000 yuan (including 15000 yuan), individuals pay 13% in the first-level hospital, 15% in the second-level hospital and17% in the third-level hospital; If the individual pays more than RMB 15000, the first-level hospital pays 1 1%, the second-level hospital pays 13%, and the third-level hospital pays 15%.

Medical reimbursement process:

1. First of all, the applicant needs to apply for reimbursement;

2. Subsequently, submit the relevant application materials required for reimbursement, and the place where the materials are submitted is the Medical Insurance Section of the Social Security Branch of the Social Security Fund Administration required by the insured;

3. Review the data, and if it meets the reimbursement conditions, it will be reimbursed according to the regulations.

The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts. All the basic medical insurance premiums paid by the employer are used to establish the overall fund. The overall fund and individual account shall delimit their respective payment ranges, and shall be accounted for separately, and shall not occupy each other. Determine the qifubiaozhun and the maximum payment limit of the overall fund. In principle, the qifubiaozhun is controlled at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled at about 4 times of the average annual salary of local employees. Medical expenses below Qifubiaozhun shall be paid by personal account or borne by individuals. Medical expenses above Qifubiaozhun and below the maximum payment limit are mainly paid from the overall fund, and individuals also have to bear a certain proportion. Medical expenses exceeding the maximum payment limit can be solved by means of commercial medical insurance. The specific qifubiaozhun, maximum payment limit and personal burden ratio of medical expenses above the qifubiaozhun and below the maximum payment limit of the overall planning fund shall be determined by the overall planning area according to the principle of balance of payments.

The difference between residents' medical insurance and employees' medical insurance lies in:

1. The coverage of residents' medical insurance is relatively wider, including the elderly and children, people who have not participated in employee medical insurance, etc. The objects of employee medical insurance mainly include employees in enterprises and institutions and flexible employees.

2. The requirements for household registration are different, and residents' medical insurance can only be participated in the household registration; There is no household registration requirement for employee medical insurance, as long as it is at the workplace;

3. The subjects and methods of premium payment are different. Residents' medical insurance generally requires individuals to bear all the expenses, but the state will have certain subsidies, and residents' medical insurance also has a time limit for payment. If you miss the payment time, you will not be able to repay (except in special circumstances, such as newborns born that year, but you need to bear all the expenses yourself); Employee medical insurance is that units and individuals pay premiums once a month, and can also be insured as flexible employees, but they need to bear all the premiums themselves;

4. The reimbursement rate of employees' medical insurance is higher than that of residents' medical insurance due to different reimbursement standards;

5. Employees' medical insurance can be divided into individual accounts and overall accounts, but residents' medical insurance is not included.

Legal basis:

Social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund 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.