1, 80% of the deductible from 800 yuan to 5,000 yuan;
2, 5000 yuan to 10000 yuan part according to 85% reimbursement;
3, 10000 yuan to the highest payment limit is reimbursed by 90%;
4. Retirees will be increased by 5% on the basis of the above reimbursement ratio.
Outpatient reimbursement process of Lianyungang 3A Hospital:
1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;
2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day;
3. After the social security agency reviews the materials and approves the application, the applicant receives the reimbursement form of social medical insurance medical expenses and submits it for reimbursement.
To sum up, the reimbursement ratio of the top three hospitals is determined according to the segments of reimbursement. The higher the hospital level, the more reimbursement segments and the lower the reimbursement ratio.
Legal basis:
Article 2 of People's Republic of China (PRC) Social Insurance Law
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
Article 26
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Article 28
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.