How much can medical insurance reimburse

Medicare reimbursement in a settlement year, incurred in line with the scope of reimbursement of medical expenses of less than 180,000 yuan, the starting standard for third-level hospitals 650 yuan, reimbursement rate of 50%, the upper limit of 2,000 yuan, second-level hospitals starting standard of 300 yuan, reimbursement rate of 60%, the first level of hospitals do not have a starting standard, reimbursement rate of 65%.

Medicare reimbursementThe scope of urban medical insurance reimbursement refers to all employers in towns and cities, as follows:

1, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.);

2, organs, institutions, social organizations, private non-enterprise units and their employees are required to participate in the basic medical insurance;

3, some towns require that township enterprises and their employees participate in basic medical insurance;

4, some towns require that township enterprises and their employees participate in the basic medical insurance.

3. Some cities and towns require that township and village enterprises and their employees, as well as owners of urban self-employed economic organizations and their employees, be gradually included in the scope of basic medical insurance (the last of which is subject to different policies in different localities), so that they can enjoy medical reimbursement.

Medical reimbursement in cities and towns mainly refers to hospital visits, medication, hospitalization, surgery, etc., which can be reimbursed through the medical insurance card in accordance with the relevant regulations. Generally speaking, Class A drugs can enjoy full reimbursement, while Class C requires all out-of-pocket expenses, and Class B reimbursement is 80%, with 20% out-of-pocket expenses. When insured employees travel on business or visit relatives abroad and incur medical expenses, they are only reimbursed for emergency medical expenses in accordance with the medical insurance regulations, and no reimbursement will be made for hospitalization for non-emergency reasons. If an insured employee resides abroad for more than six months, he/she will be reimbursed for his/her medical expenses in the same way as a long-term resident. Long-term residents should be certified by their units, identify two designated hospitals (which should be local medical insurance designated medical institutions), and promptly apply for the "Zhenjiang City Long-term Resident Medical Expense Reimbursement Card for Out-of-Town Employees".

Legal basis

Article 30 of the Social Insurance Law of the People's Republic of China*** and the State of China, the following medical expenses shall not be included in the scope of payment of the basic medical insurance fund:

(1) those that should be paid from the Industrial Injury Insurance Fund;

(2) those that should be borne by the third party;

(3) those that should be paid by the public**** health insurance fund. ) should be borne by the public ****health;

(iv) medical treatment outside the country.

Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.