The treatment expenses of medical insurance reimbursement are mainly limited in the medical insurance catalogue, and only hospitals, drugs and treatment items stipulated by medical insurance can be reimbursed. The most common scenes in the actual use of medical insurance are outpatient visits and hospitalization, and the specific reimbursement methods of medical insurance are generally divided into these two situations:

Outpatient reimbursement: after outpatient expenses reach a certain amount (subject to local medical insurance policy), the excess part can enjoy medical reimbursement. There are no other procedures, and the medical insurance card is directly used for real-time settlement. The user only needs to reimburse and then pay the fee.

Hospitalization reimbursement: when hospitalized in a designated medical insurance hospital, a medical insurance card is issued, and the information of the insured person is read by the unified medical insurance settlement system, and the hospitalization number is processed. When leaving the hospital, the hospital will settle accounts with the social security center and automatically deduct the reimbursement amount. After reimbursement, patients only need to pay other personal expenses.

Because the proportion of medical insurance reimbursement varies from place to place, please refer to local policies for details. Let's take Shenzhen as an example to introduce the proportion of medical insurance reimbursement.

Outpatient treatment:

Hospitalization:

In addition to the prescribed reimbursement ratio, there is also a certain range of medical insurance reimbursement. Above the deductible line and below the capping line, after deducting the self-funded part and the self-funded part, it is the part of medical insurance reimbursement. (see the picture below)

The relationship between medical insurance and commercial insurance can be summarized in one sentence: medical insurance is the foundation and commercial insurance is the supplement. Whether it is the rural new rural cooperative medical system, residents' medical insurance or urban workers' medical insurance, these basic medical insurance are the welfare of the state and must be distributed.