1. The outpatient medical expenses that meet the requirements shall be reimbursed according to the following proportion, and the rest shall be paid by the individual:
(1) medical expenses less than 1000 yuan will be reimbursed by 35%.
(2) Medical expenses 1 1,000 yuan or more (including 1 1,000 yuan), and the part less than 5,000 yuan will be reimbursed by 45%.
(3) When the medical expenses are more than 5000 yuan (including 5000 yuan) 10000 yuan, 55% will be reimbursed.
(4) Medical expenses above 10000 yuan (including10000 yuan) shall be reimbursed by 65%.
2, in line with the provisions of the hospital medical expenses, according to the following proportion of reimbursement, the rest of the individual pays:
(1) If the medical expenses are less than RMB 10000, the reimbursement rates in tertiary, secondary and primary medical institutions are 55%, 65% and 75% respectively.
(2) If the medical expenses 10000 yuan or more (including 10000 yuan) is less than 20000 yuan, the reimbursement rates in tertiary, secondary and primary medical institutions are 60%, 70% and 80% respectively.
(3) If the medical expenses are more than 20,000 yuan (including 20,000 yuan), the reimbursement rates in tertiary, secondary and primary medical institutions are 65%, 75% and 85% respectively.
Medical insurance reimbursement materials:
1, medical insurance card: hold a valid medical insurance card;
2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.
3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;
4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;
5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;
6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.
To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.
Legal basis:
Article 2 of People's Republic of China (PRC) Social Insurance Law
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
essay
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.