Reimbursement ratio: For medical expenses above the minimum payment standard of the medical insurance pooling fund and below the maximum payment limit, the payment ratio shall not be less than 75%. Hospitalization threshold: RMB 240 for first-level medical institutions, RMB 480 for second-level medical institutions, and RMB 720 for third-level medical institutions. The maximum payment limit: Calculated on a one-year basis, it should reach 4 times the average salary of employees on duty in the previous year as stipulated by the state. Special disease outpatient clinic: In principle, the overall fund payment ratio should not be less than 80% for outpatient treatment of special diseases such as malignant tumor outpatient radiotherapy and chemotherapy, uremic hemodialysis, and anti-rejection treatment after liver and kidney transplantation.

Harbin Medical Insurance Reimbursement Ratio

1. Outpatient medical expense reimbursement ratio

1. For medical expenses less than 1,000 yuan, 35% will be reimbursed;

2. If the medical expenses are more than 1,000 yuan (including 1,000 yuan) and less than 5,000 yuan, 45% will be reimbursed;

3. The medical expenses are more than 5,000 yuan (including 5,000 yuan) and less than 5,000 yuan will be reimbursed. For the part of 10,000 yuan, 55% will be reimbursed;

4. For the part of medical expenses above 10,000 yuan (including 10,000 yuan), 65% will be reimbursed.

2. Reimbursement ratio for hospitalization medical expenses

1. The portion of medical expenses less than 10,000 yuan

①The reimbursement ratio for third-level hospitalization medical expenses is 55%;< /p>

②The reimbursement ratio for second-level hospitalization medical expenses is 65%;

③The reimbursement ratio for first-level hospitalization medical expenses is 75%.

2. The part of medical expenses above 10,000 yuan (including 10,000 yuan) and the part less than 20,000 yuan

①The reimbursement rate for third-level hospitalization medical expenses is 60%;

②The reimbursement rate for secondary hospitalization medical expenses is 70%;

Harbin medical insurance payment standard;

1. The payment standard for adult residents is 290 yuan,

2. The standard payment for students and children is 50 yuan.

3. The individual contributions of subsistence allowance recipients, severely disabled people and seniors over 60 years old from low-income families are fully subsidized by the government.

Legal basis:

"Social Insurance Law of the People's Republic of China" Article 30 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) Should be paid from the work-related injury insurance fund;

(2) Should be borne by a third party;

(3) Should be borne by the public health department ;

(4) Seeking medical treatment abroad.

Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.