According to the Social Insurance Law of the People's Republic of China and related regulations, the reimbursement rate for employee health insurance is generally 80%, which means that 80% of the medical expenses can be reimbursed by the social medical insurance fund, and the remaining 20% needs to be borne by the individual. However, it should be noted that this ratio is for different medical programs, and different programs may have different reimbursement ratios, such as special diseases, serious illnesses, outpatient services, etc. In addition, the reimbursement rate of employee health insurance is not applicable to all medical expenses, the specific requirements also need to meet the relevant provisions of the health insurance policy, such as inpatient treatment needs to be carried out in designated hospitals, outpatient treatment needs to be reimbursed in advance, etc. The specific requirements vary from region to region, and the participants need to pay for their own expenses. The specific requirements vary from region to region, and participants should pay more attention to the social security policies and regulations in their own regions. In short, it is very important to understand the reimbursement rate of the employee health insurance for the insured person, which can help him to know his rights and benefits in time, plan his medical expenses reasonably and save his personal medical expenses.
Can I increase my reimbursement rate through other means? In addition to the employee health insurance reimbursement rate, some regions have also implemented policies such as the health insurance co-ordination fund and commercial medical insurance, which can appropriately increase the reimbursement rate. However, the specific implementation details of these policies vary from region to region, so you need to check the local social security policy related information and follow the requirements.
The reimbursement rate of employee health insurance is one of the important indicators for participants to enjoy social insurance treatment. Participants should carefully understand the social security policies and regulations, and comply with the relevant social security regulations, but also through the understanding of other health insurance policies to improve their reimbursement rate.
Legal basis:
Article 40 of the Social Insurance Law of the People's Republic of China*** and the State The sources of the social insurance fund include: (1) social insurance premiums paid by participants and employers in accordance with the provisions of the social insurance fund; (2) appropriations by the state, local and relevant departments; (3) social donations; (4) other lawful income.