China's medical insurance is divided into two parts: individual account and social pooling fund, which are jointly funded by units and individuals in accordance with the prescribed proportion to ensure citizens' basic medical needs. Among them, the overall fund is used to pay the hospitalization expenses, the personal account is used to pay the outpatient and emergency expenses and the drug purchase expenses of designated retail pharmacies, and the expenses that need to be borne by individuals in specific projects of hospitalization and outpatient services are also paid by personal accounts, and the personal accounts are paid by individuals if the funds are insufficient.

The proportion of medical insurance reimbursement is as follows:

1, employee medical insurance reimbursement ratio:

If the insured workers are still working, the medical expenses above Qifubiaozhun and below the maximum payment limit incurred in hospitalization shall be shared by the medical insurance fund and individuals. The proportion of personal commitment is 6% in the first-class hospital, 8% in the second-class hospital, and 10% in the third-class hospital. The personal commitment of retirees and employees who have worked for more than 30 years will be halved. In a natural year, the maximum payment limit of medical insurance fund is 50 thousand yuan; The maximum payment limit of medical assistance fund is 6.5438+0.7 million yuan.

2, the proportion of medical insurance reimbursement for retired workers:

The medical expenses incurred by retired workers for medical treatment are above the deductible and below the maximum payment limit, which is in line with the hospitalization medical expenses paid by the basic medical insurance. Class A drugs and general medical expenses are paid by the on-the-job employee pooling fund, and the retirees pooling fund pays 90%; 75% of the cost of Class B drugs is paid by the overall fund; 70% of the cost of high-tech examination and treatment is paid by the overall fund.

3, employee health insurance regulations:

The funds in the employee's personal medical insurance account shall not be used for other purposes, and can only be used for my medical and health expenses; The insured person's personal account can also be used to buy drugs and medical devices within the prescribed scope in designated retail pharmacies. In the future, the insured can buy all drugs with quasi-brand names and medical devices with brand names in designated retail pharmacies with social security cards.

To sum up, the establishment and improvement of medical insurance system will further promote social progress and production development. On the one hand, medical insurance relieves the worries of workers, makes them work with peace of mind, can improve labor productivity and promote the development of production; On the other hand, it also ensures the physical and mental health of workers and the normal reproduction of labor.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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.