The reimbursement ratio of residents’ medical insurance is as follows:

1. Outpatient reimbursement ratio standard:

(1) If you seek treatment at the local village center clinic For medical treatment, the reimbursement rate standard is 60%, and if it falls within the scope of medical insurance, there is a limit on the cost of medicine for each medical visit, which is limited to 10 yuan, and the medicine fee for temporary rehydration prescriptions by doctors at the health center is limited to 50 yuan;

(2) If you seek medical treatment at the local town health center, the reimbursement rate standard is 40%, the examination fees and surgical fees required for each medical visit are limited to 50 yuan, and the prescription drug fee is limited to 100 yuan; also That is to say, if your medical expenses are between 200 and 500 yuan, you can only be reimbursed up to 100 yuan;

(3) If you seek medical treatment at a local secondary hospital, the standard reimbursement rate is 100%. 30, the examination fee and operation fee limit for each visit is 50 yuan, and the prescription drug fee limit is 200 yuan;

(4) If you see a doctor in a local tertiary hospital, the standard reimbursement rate is 100% 20, each examination fee and operation fee limit is 50 yuan, and the prescription drug fee limit is 200 yuan.

2. Reimbursement ratio standards for hospitalization:

(1) Reimbursement ratio standards for auxiliary examinations and drugs: ECG, X-ray, film, laboratory tests, physical therapy, acupuncture, CT The reimbursement limit for various examination fees such as MRI, MRI and MRI is 200 yuan; that is to say, if a radiograph requires 400 yuan, only 200 yuan will be reimbursed at the final reimbursement;

(2) Surgery fee reimbursement ratio Standard: Refer to the national standard, if the amount exceeds 1,000 yuan, the reimbursement will be 1,000 yuan; for the elderly over 60 years old who are hospitalized in the health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan;

(3) Each hospitalization fee The reimbursement ratio standard for first-level hospitals is: the reimbursement ratio for town health centers is 60%; the reimbursement ratio for second-level hospitals is 40%; the reimbursement ratio for third-level hospitals is 30%.

3. Serious illness reimbursement ratio standard:

(1) If you have participated in local medical insurance and paid, the serious illness reimbursement ratio is one-time or the annual medical expenses exceed 5,000 yuan. Compensation will be made in stages. If the medical expenses are between 5,001 and 10,000 yuan, the compensation standard is 65%. If the medical expenses are between 10,001 and 18,000 yuan, the compensation standard is 70%;

(2) If you participate in the local medical insurance payment, the reimbursement rate for serious illness will be divided into segments if the one-time or annual medical expenses exceed 5,000 yuan. If the medical expenses are between 5,001 and 10,000 yuan, the compensation standard is 65%. The compensation standard for medical expenses between 10,001 and 18,000 yuan is 70%;

(3) If you have participated in local medical insurance and paid for it, the town-level cooperative medical inpatient and uremia outpatient hemodialysis and tumor outpatient clinics The annual reimbursement limit for radiotherapy and chemotherapy compensation is 11,000 yuan.

Materials for employee medical insurance reimbursement:

1. Copy of ID card;

2. Copy of the first page of the household register and the person reimbursing;

< p>3. Disease diagnosis certificate (with the official seal of the hospital);

4. Bill of expenses (with the seal of the hospital);

5. Invoice issued by the hospital (with the seal of the hospital) ;

6. Copy of medical insurance card (bank card).

To sum up, after an employee becomes ill and is hospitalized, the employee medical insurance will reimburse him or her. As long as the reimbursement conditions of the employee medical insurance are met and the hospitalization notice and ID card issued by the outpatient medical service are used to register directly with the medical insurance management agency, After being discharged from the hospital, employees can go to the medical insurance management center to apply for reimbursement for inpatient and outpatient serious illness with the settlement voucher issued by the hospital.

Legal basis:

Article 23 of the "Social Insurance Law of the People's Republic of China"

Employees shall participate in employee basic medical insurance, which shall be provided by the employer Units and employees must pay basic medical insurance premiums together in accordance with national regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.