1, reimbursement ratio of employee medical insurance hospitalization:
(1) 85% of hospitalization expenses are between 1300 yuan-30,000 yuan;
(2) The reimbursement rate between 30,000 yuan and 40,000 yuan is 90%;
(3) The reimbursement rate between 40,000 yuan and10,000 yuan is 95%;
(4) The reimbursement rate between10-300,000 yuan is 85%.
2, the proportion of residents' medical insurance reimbursement:
(1) The reimbursement rate of first-class hospitals is 65%;
(2) 80% of the second-level hospitals are reimbursed for more than 6,000 yuan.
Medical insurance reimbursement process:
1, diagnosis and treatment in designated medical insurance hospitals: every city will have designated medical insurance hospitals, and only in designated medical insurance hospitals can medical insurance be used for reimbursement. Therefore, if you want to use medical insurance, you must go to the designated hospital for medical insurance and go through the relevant registration procedures;
2. Prepare discharge materials: prepare discharge materials in advance when leaving the hospital, such as disease diagnosis, discharge records, medical records, etc. Usually talk to the doctor during treatment. If we need these materials, the doctor will help us prepare them. You'd better make a copy of these materials after you get them. One is submitted to the medical insurance reimbursement office, and the other is reserved for use;
3. Discharge settlement: Take the hospitalization list and invoice and go to the hospital for settlement. After that, you can take the relevant information to the medical insurance reimbursement department for reimbursement review;
4. Waiting for expense reimbursement to arrive: After the materials are handed over, a receipt will be received, and the reimbursement amount will arrive in 15 days. You just have to wait patiently.
To sum up, the minimum reimbursement rate of employee medical insurance is about 70%, and the maximum reimbursement rate is about 95%. The minimum reimbursement rate of medical insurance for urban residents is about 55%, and the maximum reimbursement rate is over 70%.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.