During the treatment of illness or injury, the proportion of medical insurance reimbursement is: in a natural year, if the compliance medical expenses borne by individuals exceed the deductible line of serious illness insurance, compensation will be made in seven stages in principle: 50% for the part within 30,000 yuan, 55% for the part above 30,000 yuan to 50,000 yuan, 60% for the part above 50,000 yuan to 80,000 yuan, and 65% for the part above 80,000 yuan to 6,543.8+for the part above 65,000 yuan. 75% will be reimbursed for the part above 654.38+0.2 million yuan, 80% for the part above 654.38+0.5 million yuan, and the annual cumulative compensation amount will not exceed 200,000 yuan. If the referral is not made according to the relevant policies, the payment ratio should be reduced. It should be noted that if the total personal self-sufficiency of hospitalization medical expenses of urban and rural residents insured in the city exceeds the deductible line for serious illness compensation, the serious illness insurance will compensate according to the prescribed proportion.
legal ground
"People's Republic of China (PRC) Social Insurance Law" Article 23 * * * employees shall participate in the basic medical insurance for employees, and employers and employees shall pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations. Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.