Money reimbursed by medical insurance = (all expenses of Class A drugs+self-paid part deducted by Class B drugs+other expenses meeting medical insurance regulations)-deductible line * corresponding reimbursement ratio.

Qifubiaozhun, also known as Qifubiaozhun, refers to the amount of expenses that the insured needs to pay in advance before enjoying the reimbursement of medical expenses.

The maximum payment limit, also known as the "capping line", refers to the upper limit of the basic medical insurance fund to pay the medical expenses of the insured. Medical expenses exceeding the maximum payment limit will not be paid by the basic medical insurance fund.

What is the general reimbursement rate of people's hospitals?

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%; For general outpatient service, reimbursement ratio: medical expenses above the 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: less than 5,000 yuan (including 5,000 yuan), individual pays 0/5% for first-class hospitals, 0/7% for second-class hospitals and 0/9% for third-class hospitals; 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%.

Generally speaking, reimbursement amount = (total medical expenses-deductible-deductible) * reimbursement ratio.

Legal basis:

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

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.