How much can medical insurance be reimbursed?

Under normal circumstances, the proportion of medical insurance reimbursement fluctuates around 70%. The proportion of reimbursement is related to medical grade, examination, medication and other factors. Class A drugs can be reported in full, class B drugs can be reported at their own expense, and class C drugs need to be reported at their own expense.

The reimbursement rate varies from place to place. Please consult the local medical insurance bureau. Medical insurance reimbursement can be found on the local social security website. To enjoy medical insurance benefits, you need to see a doctor at a designated medical institution.

Not all medical insurance can be reimbursed, and individuals have to bear part of it, with a maximum payment limit.

Personal burden includes:

General outpatient (emergency) consultation fee;

Drug purchase expenses of designated retail pharmacies;

Hospitalization (outpatient prescribed diseases) part of the cost should also be paid;

The maximum payment limit refers to the maximum amount of medical expenses paid by the basic medical insurance fund to the insured in a medical year. The standard is about 4 times the average wage of employees in this city last year.

If it is not a work-related injury, medical insurance is responsible for reimbursement. At present, medical insurance policies vary from place to place. Generally, the medical expenses for accidental injuries are written off according to the proportion of natural diseases and physiological diseases, and some areas stipulate that such medical expenses should be appropriately reduced by 10-20 percentage points.

The proportion of reimbursement for accidental injuries in general commercial insurance may be different in different insurance companies and different types of insurance. For customers of Xinhua Life Insurance Company who are treated in an approved hospital due to accidental injury, the reasonable medical expenses incurred within 180 days from the date of accidental injury will be reimbursed at the rate of 80% after deducting the absolute deductible of 50 yuan. If compensation or compensation has been obtained from social security or other means, the rest will be compensated.

The Social Insurance Law stipulates that 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.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.