What is the reimbursement ratio of medical insurance, and the general reimbursement ratio of medical

Medical insurance for each region.

The rates of reimbursement are all different:

1. Medical insurance for urban and rural residents.

1. Insured residents are in designated medical institutions in the overall planning area.

Inpatient medical expenses incurred within the scope of the policy shall be covered by the medical insurance for urban and rural residents**.

Pay on a pro-rata basis.

2. Outpatient reimbursement:

Village clinic. The proportion of hospital payment is: 70%, and the insured residents are 30% of township health centers.

Community health service center: 60%, insured residents are responsible: 40%3, hospitalization reimbursement:

No less than 85% of township health centers, no less than 70% of county-level hospitals, no less than 60% of city-level hospitals, and no less than 50% of provincial-level hospitals. Failure to follow the hierarchical diagnosis and treatment system.

For those who go through referral procedures (except for the rescue of critically ill patients), the payment ratio will be reduced by 15%.

2. Medical insurance for urban workers.

Employee medical insurance reimbursement: a type of charging standard designated hospitals: the minimum payment standard is 900 yuan, and the reimbursement of less than 10,000 yuan is 12%.

Designated hospitals with second-class charging standards: the minimum payment standard is 600 yuan, and the reimbursement for less than 10,000 yuan is 9%.

Designated hospitals with three types of charging standards: the minimum payment standard is 300 yuan, and the reimbursement for less than 10,000 yuan is 5%.

3. Commercial medical insurance.

The reimbursement ratio of commercial medical insurance is generally more than 80%, as long as it is in a hospital at or above the county level, there is no "threshold" for commercial medical insurance admission, and within the scope of insurance, the insured can be reimbursed according to the proportion of 80%. 100% reimbursement can be made with medical insurance and 60% without medical insurance.

1. Medical insurance for urban and rural residents.

1. The hospitalization medical expenses incurred by the insured residents in the designated medical institutions in the overall planning area within the scope of the policy shall be paid by the urban and rural residents' medical insurance** in proportion.

2. Outpatient reimbursement:

Village clinics: 70% for hospitals and 30% for insured residents

Township health centers and community health service centers: 60%, insured residents are responsible for 40%.

3. Hospitalization reimbursement:

No less than 85% of township health centers, no less than 70% of county-level hospitals, no less than 60% of city-level hospitals, and no less than 50% of provincial-level hospitals. For those who fail to go through the referral procedures in accordance with the hierarchical diagnosis and treatment system (except for the rescue of critically ill patients), the payment ratio will be reduced by 15%.

2. Medical insurance for urban workers.

Employee medical insurance reimbursement: a type of charging standard designated hospitals: the minimum payment standard is 900 yuan, and the reimbursement of less than 10,000 yuan is 12%.

Designated hospitals with second-class charging standards: the minimum payment standard is 600 yuan, and the reimbursement for less than 10,000 yuan is 9%.

Designated hospitals with three types of charging standards: the minimum payment standard is 300 yuan, and the reimbursement for less than 10,000 yuan is 5%.

3. Commercial medical insurance.

The reimbursement ratio of commercial medical insurance is generally more than 80%, as long as it is in a hospital at or above the county level, there is no "threshold" for commercial medical insurance admission, and within the scope of insurance, the insured can be reimbursed according to the proportion of 80%. 100% reimbursement can be made with medical insurance and 60% without medical insurance.

The reimbursement ratio of medical insurance lead is as follows:

1. Basic medical insurance: usually between 50% and 90%, and the specific proportion will be different for different projects, different levels of hospitals, and different provinces. For example, the reimbursement rate for general outpatient expenses is between 50% and 80%, and the reimbursement rate for inpatient expenses is between 80% and 90%;

1. Critical illness insurance: usually between 70% and 90%, and some areas can even reimburse 100% of the cost. Critical illness insurance generally only covers specific critical illnesses, such as malignant tumors, leukemia, hepatitis, etc. To apply for a health insurance card, you need to follow the steps:

1. Prepare materials. Generally, you need to bring the original and copy of your valid identity document, social security card or social guarantee and other relevant materials;

2. Go to the local Huai Sui Chun Medical Insurance Bureau or Medical Insurance Card Service Center.

According to the specific local policy, you can go to the local medical insurance bureau or medical insurance card service center to apply for a medical insurance card;

3. Fill in the application form and submit materials. You need to fill in the application form for the medical insurance card and submit the relevant materials, and the staff will verify and review the materials you submit.

4. Wait for the card to be issued. Generally speaking, it takes a certain amount of time to make a medical insurance card, and you need to be patient;

5. Get a medical insurance card. After the card is issued, you can bring your valid ID card to the medical insurance card service center to collect the medical insurance card.

To sum up, the medical insurance card application process may be different in different regions, and the specific processing methods and required materials may vary from region to region and policy, so it is recommended that you understand the relevant local policies and procedures in advance before applying.

Legal basis]:

Article 38 of the Insurance Law of the People's Republic of China.

The following expenses incurred due to work-related injuries shall be paid from work-related injury insurance** in accordance with national regulations:

1) Medical expenses and expenses for work-related injuries;

2) Hospitalization meal subsidy;

3) Transportation and accommodation expenses for medical treatment outside the overall planning area;

4) The cost of installing and configuring assistive devices for the disabled;

5) For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee;

6) A one-time disability allowance and a monthly disability allowance for employees with disabilities of grades 1 to 4;

7) A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved;

8) In the case of work-related death, the bereavement subsidy received by the surviving family members, the pension for supporting relatives and the work-related death subsidy;

9) Labor ability appraisal fee.

According to the provisions of the relevant laws of our country, it can be seen that in-service employees should pay basic medical insurance, and generally the annual hunger is paid by the employer and the employee, and only those who meet certain conditions can enjoy the basic medical insurance treatment.

What is the reimbursement ratio of medical insurance?

1. Reimbursement ratio for outpatient services.

1) Employee medical insurance:

1. After the in-service employees go to the outpatient and emergency departments of the hospital, the medical expenses of more than 1,800 yuan can be reimbursed, and the reimbursement ratio is 90 in community hospitals and 70 in other designated hospitals, and the maximum limit can be reported as 20,000 yuan.

For retirees under the age of 1,300, expenses above 1,300 yuan can be reimbursed, and the reimbursement ratio is 85 (non-community hospitals (community hospitals).

Retirees over the age of 1,300 yuan can be reimbursed 90 yuan regardless of any hospital.

4. No matter what type of person, the maximum amount of outpatient and emergency medical expenses paid is 20,000 yuan.

2) College Students:

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

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

2. Employee medical insurance: reimbursement ratio of hospitalization expenses.

1. Minimum payment standard: In a medical insurance year, the minimum payment standard for the first hospitalization is 1,300 yuan, and the second and subsequent hospitalizations are 650 yuan.

2. Reimbursement ratio: The method of segmented calculation and cumulative payment of limb hunger is adopted, and the payment ratio is calculated separately according to the level of the hospital.

3. Payment limit: The cumulative maximum payment limit of basic medical insurance co-ordination ** in a year is 100,000 yuan, and the cumulative maximum payment limit of large mutual aid funds is 200,000 yuan, a total of 300,000 yuan.

The law stipulates that Article 29 of the Social Insurance Law of the People's Republic of China stipulates: "The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institutions and drug business units."

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Article 29 of the Social Insurance Law of the People's Republic of China The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institutions and drug business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the insured to enjoy basic medical insurance benefits. Article 28 of the Social Insurance Law of the People's Republic of China in accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Legal Analysis: There are different calculation criteria depending on the population and classification.

Legal basis: Article 23 of the Social Insurance Law of the People's Republic of China Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons can participate in the basic medical insurance for employees, and the gods of the Geyan School shall pay the basic medical insurance premiums in accordance with the provisions of the state.

The reimbursement is not the same in different places, hope.

The specific reimbursement ratio must be referred to:

First, the use of special medical materials or the use of disposable medical materials with a unit price of more than 1,000 yuan, as well as the installation and replacement of artificial organs, will be co-ordinated by the basic medical insurance ** according to the domestic universal ** pay 90%;

Second, 90% of the basic medical expenses for chronic renal failure in the outpatient clinic, anti-rejection drugs in the outpatient clinic after organ transplantation, and chemotherapy, radiotherapy, intervention** or radionuclide for malignant tumors in the outpatient clinic** will be paid by the basic medical insurance**;

Thirdly, 80% of the cost of outpatient special examination** is paid by the basic medical insurance**, and 20% is paid by the individual;

Fourth, continuous payment is linked to the reimbursement ratio, which increases to 71% after 2 consecutive years of insurance, 72% after 4 years of continuous insurance, and so on.

It should be reminded that in different cities, the reimbursement ratio of social security card is different, which is mainly related to the local medical insurance treatment, it is recommended to call social security **12333 for consultation, or consult with the local social security bureau.

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Medical insurance is divided into employee medical insurance and urban and rural residents' medical insurance, and the reimbursement ratio varies from place to place. Take Beijing employee medical insurance as an example: the maximum limit is 20,000 yuan.

In-service employees can be reimbursed for outpatient and emergency medical expenses of more than 1,800, with a reimbursement ratio of 50%; Retirees can be reimbursed for outpatient and emergency medical expenses of more than 1,300 yuan, 70% for those under 70 years old, and 80% for those over 70 years old.

Medical insurance is mainly divided into employee medical insurance and urban and rural residents' medical insurance, and the reimbursement ratio varies from place to place. Employee health insurance: Reimbursement rates vary for active employees, retirees under the age of 70, and retirees over the age of 70.

As for the medical insurance for urban and rural residents, the starting line and reimbursement ratio are different in different places. You can log on to the official website of the local human resources and social security bureau for inquiries.