1, outpatient reimbursement ratio. There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. In a medical insurance year, there is no deductible for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed at the rate of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan;

2. The proportion of hospitalization reimbursement. The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively;

3, the proportion of the second reimbursement, after the second reimbursement, the medical expenses incurred by the insured residents in a single hospitalization may have a second reimbursement, which belongs to the part of the basic medical insurance fund for urban residents. After the basic medical insurance fund is paid in proportion, if the personal burden exceeds 8,000 yuan, the serious illness insurance fund will reimburse the excess part twice according to the proportion of 55%. After the basic medical insurance payment and the "second reimbursement", the annual accumulated hospitalization medical expenses of the insured residents (including the compliant and reasonable self-funded part) exceed 25,000 yuan, and the excess part is reimbursed again by the serious illness insurance fund according to the proportion of 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan;

4. Reimbursement amount. The maximum annual reimbursement is 370,000 yuan for residents who participate in medical insurance for urban residents in our city. The annual payment limit for basic medical insurance is 6,543,800 yuan+0.2 million yuan, and the annual payment limit for serious illness insurance is 250,000 yuan. Therefore, Enoch Finance found that the insured can be reimbursed up to 370,000 yuan per year.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).

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.