The proportion of medical insurance reimbursement is usually between 50% and 95%. The specific reimbursement ratio depends on many factors, including hospital level, drug category, medical expenses of the insured, etc. For example, the threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%. In terms of drugs, Class A drugs can be fully reimbursed, Class B drugs can be reimbursed 80%, and 20% at their own expense, and Class C drugs need to be fully reimbursed. The lowest reimbursement rate of medical insurance for employees is 85% and the highest is 95%; The proportion of medical insurance reimbursement for urban and rural residents is between 50% and 80%, and the specific proportion will vary according to the regional economic level.

Medical insurance reimbursement conditions:

1. Identity of the insured: it must be a formal insured who has participated in medical insurance;

2. Limitation of reimbursement scope: Usually, only expenses incurred in medical treatment in designated medical institutions can be reimbursed;

3. Limitation of reimbursement items: generally including medicine expenses, treatment expenses, operation expenses, etc. , but some items such as beauty and plastic surgery are not within the scope of reimbursement;

4. deductible requirements: the insured must pay a certain amount before reimbursement, that is, the deductible, and the excess can be reimbursed;

5. Application of reimbursement ratio: different medical services and drugs have different reimbursement ratios, which are usually determined according to the categories of drugs and services;

6. Limit of capping line: there is a maximum reimbursement amount, and the expenses exceeding the capping line shall be borne by yourself.

To sum up, the reimbursement rate of medical insurance is usually between 50% and 95%, depending on the hospital level, drug category and medical expenses of the insured. Different hospital grades and drug categories have different qifubiaozhun and reimbursement ratio. The reimbursement rate of employees' medical insurance for hospitalization is as low as 85% and as high as 95%, while the medical insurance for urban and rural residents is between 50% and 80%, which will be different due to different regional economic levels.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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.