Outpatient reimbursement ratio:
1, if the medical expenses are insufficient 1000 yuan, 35% will be reimbursed;
2, medical expenses in 1000 yuan (including 1000 yuan) above, less than 5000 yuan, 45% reimbursement;
3, medical expenses in more than 5000 yuan (including 5000 yuan), less than 10000 yuan, 55% reimbursement;
4, medical expenses in 1 ten thousand yuan (including 1 ten thousand yuan) above, reimbursement of 65%.
Proportion of hospitalization reimbursement:
1, medical expenses 10000 yuan, medical treatment in tertiary, secondary and primary medical institutions, with reimbursement rates of 55%, 65% and 75% respectively;
2. The medical expenses are above 10000 yuan (including 10000 yuan) and within 20000 yuan, and the reimbursement rates in tertiary, secondary and primary medical institutions are 60%, 70% and 80% respectively;
3, medical expenses in more than 20000 yuan (including 20000 yuan), in the tertiary, secondary and primary medical institutions, the reimbursement rate is 65%, 75% and 85% respectively.
The medical insurance reimbursement process is as follows:
1. If local employees are hospitalized, they should be hospitalized in the designated medical insurance hospital paid by the unit. When you are hospitalized, you should submit medical insurance and medical insurance directly to the medical insurance department of your hospital, and automatically reimburse the basic medical expenses at the time of settlement;
2. Employees hospitalized in other places who are sick due to business trip or long-term work in other places must be in emergency and can be hospitalized in local hospitals, but they must report to the Municipal Supervision Department of the Medical Insurance Bureau within three days;
3. Referral to other places for medical treatment has no effect in the hospital where the unit pays, or the hospital doctor suggests transferring to other places. Must be a designated hospital, central hospital, municipal people's hospital, and send a referral letter and related inspection materials to the supervision department of the medical insurance bureau for review, and can be transferred after approval.
To sum up, medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. With the characteristics of "low level and wide coverage", the payment is based on the cost that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees of different units can enjoy the rights of basic medical insurance.
Legal basis:
Article 29 of People's Republic of China (PRC) Social Insurance Law
The medical and military expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance carport insurance agency, medical institution and pharmaceutical business unit. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
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.