How much is the reimbursement ratio of provincial medical insurance

Nowadays, many people have bought medical insurance, but there are few people who know how much money they need to pay for medical insurance every year and what expenses can be reimbursed"Medicare: What You Don't Know".

Let's get to know Medicare:

1. Type of medical insurance

Medical insurance is generally divided into two types: urban and rural residents' medical insurance and employee medical insurance, and the purchase of employee medical insurance is a must after the employer signs a labor contract with the employee, but the urban and rural residents' medical insurance is not compulsory.

2. Medical insurance costs

Employee medical insurance is paid by the employer and the employee jointly according to the fixed proportion of the total payment base every month, but the medical insurance for urban and rural residents stipulates that the payment fee is at least 250 yuan per person per year, and the annual payment fee is 250 yuan in general areas, and the fee paid in some developed areas will be higher.

3. Medical insurance reimbursement

Through employee medical insurance, you can reimburse **, outpatient, medicine, inpatient medical and other expenses, usually the reimbursement ratio is 70%-90%, and when hospitalization occurs, urban and rural residents medical insurance will be reimbursed, and the reimbursement ratio is 50%-70%.

As long as the expenses of drugs, diagnosis and treatment items and medical service facilities are within the scope of reimbursement, they can be reimbursed in accordance with the prescribed proportion for expenses that exceed the minimum payment line and do not reach the upper limit. However, in some cases, reimbursement of medical insurance is not possible, what specific situations will be included? You'll know it after reading it:

"When health insurance does not work".

Summary

Medical insurance is the basic medical security provided by the state to the people, although it is cost-effective, but the scope of protection is limited. Taking Guangdong Province as an example, the annual reimbursement of medical insurance for urban and rural residents cannot exceed 300,000 yuan, and expenses that are not on the reimbursement list, such as targeted drugs and tumor specific drugs, are not reimbursed.

If you unfortunately suffer from a serious illness, the reimbursement amount is definitely not enough, so if you want to have a secure life, commercial medical insurance must also be configured to make the future more secure. If you are very new to medical insurance and don't know which one to choose, read this article is right:"Top 10 Million Medical Insurance Inventory Worth Buying!

Hope!

After having medical insurance, if you are sick, you can use medical insurance for reimbursement, and the reimbursement ratio is different in different situations, so how is the reimbursement ratio enjoyed by using the medical insurance card in the province stipulated? In order to help you better understand the relevant legal knowledge, Hualu.com has compiled the following contents.

1. What is the reimbursement ratio of the provincial medical insurance card?

1) Reimbursement ratio for residents' outpatient serious illnesses.

For the part above 10,000 yuan to 40,000 yuan, 50% will be paid;

For the part above 10,000 yuan to 60,000 yuan, 55% will be paid;

10,000 yuan to 80,000 yuan, 60%;

65% for the part above 10,000 yuan to 100,000 yuan;

For the part above 10,000 yuan, 70% will be paid.

6. "Student children"** pay 85%.

2) Reimbursement ratio for outpatient serious illness of employees.

60% of the part above 10,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below);

65% for the part above 10,000 yuan to 60,000 yuan;

70% for the part above 10,000 yuan to 80,000 yuan;

For the part above 10,000 yuan to 100,000 yuan, 75% will be paid;

For the part above 10,000 yuan, 80% will be paid.

2. Reimbursement ratio for serious illnesses in hospitalization of residents.

1. The minimum payment standard for "residents".

Third, second, and first-class hospitals are respectively yuan, and the payment ratio is %;

2. The minimum payment standard for "students and children".

Third, second, and first-class hospitals are respectively yuan, and the payment ratio is %;

(1) Reimbursement ratio of residents' serious illness outpatient services.

50% of the part between 10,000 yuan and 40,000 yuan;

55% of the part from 10,000 yuan to 60,000 yuan;

60% of the part from 10,000 yuan to 80,000 yuan;

65% of the part from 10,000 yuan to 100,000 yuan;

For the part above 10,000 yuan, 70% will be paid.

6."Students and Children"** pay 85%.

2) Reimbursement ratio for serious illness in the outpatient department of employees.

60% of the part above 10,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below);

65% of the part between 10,000 yuan and 60,000 yuan;

70% of the part between 10,000 yuan and 80,000 yuan;

75% of the part from 10,000 yuan to 100,000 yuan;

For the part above 10,000 yuan, 80% will be paid.

Extended information: 1. The reimbursement scope of medical insurance refers to the protection of the basic medical needs of the insured and the standardization of the medication, diagnosis and treatment management of basic medical insurance. ）。The relevant medical expenses incurred by the insured in the three categories of designated hospitals shall be paid by the medical insurance** in accordance with the regulations.

2. The reimbursement scope of urban medical insurance refers to all urban employers, as follows: including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.); Organs, public institutions, social organizations, private non-enterprise units and their employees must participate in basic medical insurance; Some towns stipulate that township enterprises and their employees, as well as owners of urban individual economic organizations and their employees, should be gradually included in the scope of basic medical insurance (the last one depends on different local policies). Medical reimbursement.

3. Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. in hospitals. Medical expenses can be reimbursed through the medical insurance card in accordance with the relevant regulations. Urban medical insurance is more specific, and the scale and coverage of the project are relatively large.

Compensation for critical illness or accident is limited. At this time, the author suggests that the insured can purchase a combination of commercial medical supplementary insurance for serious illness and social security to reduce their economic losses.

1. What is the reimbursement ratio of the provincial medical insurance card?

1) 50% of the reimbursement ratio for residents' outpatient serious illnesses is more than 10,000 yuan to 40,000 yuan; For the part above 10,000 yuan to 60,000 yuan, 55% will be paid; 10,000 yuan to 80,000 yuan, 60%; 65% for the part above 10,000 yuan to 100,000 yuan; For the part above 10,000 yuan, 70% will be paid. 6."Student Child"** pays 85%.

2) 60% of the reimbursement ratio for outpatient serious illness of employees is more than 10,000 yuan (excluding 20,000 yuan, the same below) to 40,000 yuan (including 40,000 yuan, the same below); 65% for the part above 10,000 yuan to 60,000 yuan; 70% for the part above 10,000 yuan to 80,000 yuan; For the part above 10,000 yuan to 100,000 yuan, 75% will be paid; For the part above 10,000 yuan, 80% will be paid. 2. Reimbursement ratio for residents' hospitalization for serious illness1"Resident" minimum payment standard.

Third, second, and first-class hospitals are respectively yuan, and the payment ratio is %; 2."Student Child" minimum payment standard.

Third, second, and first-class hospitals are respectively yuan, and the payment ratio is %; Further information】 Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide basic medical needs for workers within the scope of protection in case of illness.

The basic medical insurance consists of a co-ordination plan and an individual account. The basic medical insurance premiums paid by individual employees are all included in personal accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is transferred to the personal account, and the other part is used to establish the overall plan**. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide basic medical needs for workers within the scope of protection in case of illness.

Composition of social co-ordinated medical insurance: the payment base is m: employee salary income + allowance.

Units pay 8% m per year; Employees pay 2% per year; Unit payment 8%m: to 7% m into the overall account (1% m to into the personal account) - hospitalization expenses; 2%m of the salary paid by the individual: 2%m goes to the personal account (plus the unit pays 1%m to the outpatient fee.