What is the reimbursement ratio of medical insurance for urban residents?

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.

Reimbursement rates vary from province to province. Domestic insurance in my place. If it is a natural disease, the reimbursement rate can reach more than 50%.

If it is an accidental injury, the reimbursement rate is about 40%. Of course, it is not necessarily strictly in accordance with this ratio. It also depends on whether the drugs you use when you are hospitalized are in the range of Class A, whether there is more in the range of Class A, and if there are more in Class B, the personal expenses will be relatively more.

Each city is different, please implement the local social security center or 12333

I will provide you with the data of Qingdao for your reference:

1. Teenagers, children, and college students.

1) Hospitalization: 80 95% reimbursement of expenses within the scope of the overall plan;

2) Outpatient serious illness: 80 95% reimbursement of expenses within the specified disease and limit;

3) Outpatient and emergency treatment in Shanghai: 90%-95% of the expenses within the scope, and the annual reimbursement limit is 2,000 yuan;

4) General outpatient clinic for college students: 60% reimbursement of expenses within the designated range.

For the above expenses, the cumulative medical insurance can pay up to 10,000 yuan in a medical year.

2. Elderly residents, severely disabled persons and non-working persons.

1) Hospitalization: 65% to 85% reimbursement of expenses within the overall scope;

2) Outpatient serious illness: 75% of the specified diseases and expenses within the limit will be reimbursed by the designated community and 65% by the designated hospital;

3) General outpatient clinics: 50% of the expenses within the designated area of the community within 1,200 yuan will be reimbursed, and 60% of the basic drugs will be reimbursed.

For the above expenses, the cumulative maximum amount of medical insurance can be paid in a medical year.

Outpatient reimbursement for urban residents in Beijing, including the elderly, students and children, and unemployed residents: 650 yuan for the minimum payment line, and the maximum amount of 2,000 yuan paid within one year, hospitalization reimbursement: 60% for the part of the elderly and unemployed residents that exceed the starting line, 70% for the part of the maximum reimbursement for 150,000 students and children who exceed the starting line, and 1,300 yuan for the first time and 650 yuan for the second and subsequent hospitalizations of 170,000 elderly and unemployed residents; The minimum payment line for the first and subsequent hospitalization of students and children is 650 yuan.

Take a look at the description of the situation when participating in the medical insurance for urban residents at that time. It may be different from place to place, and some places determine the proportion according to the level of the hospital, and deduct it directly at the time of settlement.

In your hospitalization schedule, the material cost is not reimbursed (which is also a large part of the cost). There is also the medical insurance drug divided into class A (full reimbursement), class B (reimbursement 70%-80%), category C (non-reimbursement) trauma and fracture hospital, whether you are prescribed drugs to promote bone growth (this is a class C drug). 3,000 yuan is not much.

We're 65 percent here.

The reimbursement of urban medical insurance is within the scope of medical insurance expenses, and the proportion is around 66%. The reimbursement ratio of NCMS is much lower, as if it is 50% of the reimbursement ratio of urban medical insurance, that is, about 33% of the total medical expenses, and the maximum is not more than 40%.