The reimbursement rates for different statuses are as follows: Students and children: for medical expenses up to 180,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for Level 3 hospitals is 650 RMB, and the reimbursement rate is 50%, with an upper limit of 2,000 RMB; the starting standard for Level 2 hospitals is 300 RMB, and the reimbursement rate is 60%; and Level 1 hospitals do not have a starting standard, and the reimbursement rate is 65%. Those aged 70 and above: for medical expenses under RMB 100,000 that meet the scope of reimbursement in a settlement year, the starting payment standard for Level 3 hospitals is RMB 650, with a reimbursement rate of 50% and a ceiling of RMB 2,000; the starting payment standard for Level 2 hospitals is RMB 300, with a reimbursement rate of 60%; and Level 1 hospitals do not set a starting payment standard, with a reimbursement rate of 65%. Other urban residents: for medical expenses under 100,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for third-level hospitals is 659 RMB, with a reimbursement rate of 50% capped at 2,000 RMB; the starting standard for hospitalization in second-level hospitals is 300 RMB, with a reimbursement rate of 55%; and first-level hospitals do not set a starting standard, with a reimbursement rate of 60%.
Legal basis
The People's Republic of China *** and the State Social Insurance Law Implementing Rules, Article 8 of the participants in the agreement of the medical institutions incurred medical expenses, in line with the basic medical insurance drug catalog, diagnostic and treatment items, medical services and facilities standards, in accordance with national regulations from the basic medical insurance fund. Participants in need of emergency treatment, rescue, can be in a non-agreement medical institutions; must be used for rescue drugs can be appropriately relaxed. Participants in the emergency, rescue medical services by the coordinating area in accordance with the actual situation in the local development of specific management methods.