What is the reimbursement rate for medical insurance? Can you elaborate?

Medical insurance is one of the five insurances. When we receive medical treatment in designated hospitals, we can be reimbursed by medical insurance to a certain extent based on the medical items. The reimbursement ratio is stipulated. So today, let’s take a look at the reimbursement ratio of medical insurance and the answers to related questions with the editor!

1. What is the reimbursement ratio of medical insurance?

1. Medical insurance is mainly divided into employee medical insurance and resident medical insurance, and they also have different reimbursement ratios.

2. The hospitalization reimbursement ratio of employee medical insurance is divided according to the level of hospitalization expenses. Between 1,300 yuan and 30,000 yuan, the reimbursement ratio is 85%.

3. The reimbursement rate for those between 30,000 and 40,000 yuan is 90%, the reimbursement rate for those between 40,000 and 100,000 yuan is 95%, and the reimbursement rate for those between 100,000 and 300,000 yuan is 90%. The reimbursement rate for the period is 85%.

4. Residential medical insurance is composed of the urban resident medical insurance and the new rural cooperative medical insurance. The reimbursement ratio is 65% for first-level hospitals and 80% for second-level hospitals.

5. The minimum payment threshold for county secondary hospitals is 400 yuan, the minimum payment threshold for municipal secondary hospitals is 600 yuan, and the minimum payment threshold for county tertiary hospitals is 600 yuan.

2. How to reimburse medical insurance

Medical insurance, whether it is medical treatment for urban employees or medical treatment for urban residents, first requires hospitalization in a local designated medical institution approved by the local medical insurance agency. . If you need to go to other medical institutions for treatment, you need to go to a local community hospital or community health service center or a designated medical institution to issue a transfer certificate. If you are hospitalized in a local medical insurance designated medical institution, the hospital will automatically deduct the medical insurance reimbursement from you when you are discharged from the hospital.

If you are treated at a designated location by local medical insurance but are not hospitalized, or if you receive radiotherapy, chemotherapy, etc. and are not reimbursed by the hospital, you can bring the official invoice, medical diagnosis, medication details, and social documents issued by the hospital. Go to the medical insurance window of the local administrative service center for reimbursement with your security card or medical card. If you are treated in other medical institutions and have a transfer certificate, after you are discharged or not discharged, you must submit all treatment invoices, hospital diagnosis certificates, hospitalization certificates, ID cards, social security cards, and medication before December 31 of each year. The detailed form and medical records must be submitted to the medical insurance window where your household registration (medical insurance) is located for reimbursement.

3. Medical insurance card reimbursement scope

1. It is limited to hospitalization medical expenses caused by diseases and some accidents in designated hospitals. The actual reimbursement ratio is 20 to 60%. Self-paid medicines cannot be reimbursed, and some examination and treatment fees cannot be reimbursed either.

2. The reimbursement amount within one year is four times the average salary of local social workers.

3. The medical insurance card can buy medicines and pay outpatient and emergency expenses, but it is not reimbursed.

4. The personal expenses incurred in designated medical institutions of the city and in compliance with the city's medical insurance regulations will be included in the payment scope of residents' critical illness insurance, and 50% will be reimbursed by the critical illness insurance funds.

After seeing this, the editor believes that you have also understood the relevant knowledge. When medical insurance reimburses, the relevant legal regulations have clear provisions on how much can be reimbursed, and it cannot exceed of.