The reimbursement rate of the medical insurance is: first, the amount of reimbursement can be reimbursed by the medical insurance is: reimbursement = (medical expenses - total - out-of-pocket expenses × out-of-pocket expenses - the threshold) × reimbursement rate, the reimbursement rate is about 85%. Secondly, if the person concerned incurs medical expenses exceeding the maximum payment limit of the basic medical care co-ordination fund, then the social insurance department will reimburse 85% at the rate of:0-40,000 yuan, 90% at the rate of 40,000 yuan to 80,000 yuan, and 95% at the rate of 80,000 yuan or above.
What are the items included in the medical insurance reimbursement
The classification of medical insurance reimbursement and the items included are as follows:
1, general medical insurance. It mainly includes outpatient expenses, medical expenses, examination expenses, and so on.
2, hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, surgery cost, medicine cost, etc.
3. Surgical insurance. Provides for all expenses incurred due to necessary surgery required by the patient.
4. Comprehensive medical insurance. Its cost coverage includes all costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic cost payment, the average resident family can hardly afford. Examples include cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
I hope the above can help you, if you have other questions please consult a professional lawyer.
Legal basis:
The Chinese people's *** and the basic medical insurance regulations for urban workers of the State of Article 29 of the hospitalization of serious illnesses, the medical expenses, according to the following methods of payment:
(a) the starting standard is controlled, in principle, in cities, counties, autonomous counties, the employees of the previous year's annual average social wage of 9% -11%.
(b) The maximum payment limit is, in principle, controlled at 3-5 times of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.
(3) Medical fees above the threshold and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees is appropriately taken care of.
The scope of serious diseases, the specific criteria for the starting standard and the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit shall be determined by the provincial people's government.