1, the reimbursement rate for outpatient service for special diseases is 60%, and the hospitalization limit for major diseases is 96,000 yuan.

2. The reimbursement deductible line is 2,000 yuan, and the part below 2,000 yuan will not be settled, the part from 2,000 yuan to 96,000 yuan will be settled by 50%, and the part from 96,000 yuan to the highest payment limit will be settled by 55%.

3. After payment, the medical expenses paid by the medical insurance fund shall be borne by the insured.

Medical insurance reimbursement materials:

1, medical insurance card: hold a valid medical insurance card;

2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.

3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;

4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;

5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;

6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.

To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

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The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.

Article 4

Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.