1, medical expenses of students and children that are eligible for reimbursement within a settlement year:

(1) The reimbursement rate of tertiary hospitals is 55%;

(2) The reimbursement rate of secondary hospitals is 60%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 65%;

2, in a settlement year, the elderly over the age of 70, in line with the scope of reimbursement of medical expenses:

(1) The reimbursement rate of tertiary hospitals is 50%;

(2) The reimbursement rate of secondary hospitals is 60%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 65%;

3, other urban residents in a settlement year, in line with the scope of reimbursement of medical expenses:

(1) The reimbursement rate of tertiary hospitals is 50%;

(2) The reimbursement rate for hospitalization in secondary hospitals is 55%;

(3) There is no Qifubiaozhun for the first-level hospitals, and the reimbursement rate is 60%.

The materials required for reimbursement are as follows:

1, original ID card or social security card;

2, the original certificate of disease diagnosis issued by the designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If it is an agent, you need to provide the original ID card of the agent.

The medical insurance reimbursement process is as follows:

1. When the applicant submits the application materials, the accepting department shall review the application materials within 5 days from the date of receiving the application materials and decide whether to accept them;

2. If the application materials are incomplete, inform the applicant of all the contents that need to be corrected at one time within the above 5 days;

3. The applicant shall make corrections within 5 days from the date of receiving the notice of correction of materials;

4, overdue correction, as the withdrawal of the application;

5. However, after the materials are corrected, the applicant may reapply within the statutory validity period;

6. After the Social Insurance Fund Administration has reviewed the materials and approved the application, the applicant will receive the reimbursement form for medical expenses of social medical insurance and be reimbursed.

To sum up, the reimbursement rate of residents' medical insurance is 65% in first-class hospitals and 80% in second-class hospitals.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

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.