2, hospitalization medical expenses deductible. There is a deductible for medical reimbursement. If the medical expenses do not reach the deductible line stipulated by the hospital, you need to bear the medical expenses yourself. Different hospitals have different deductible lines. Details are as follows:
1) employee medical insurance deductible line: first-class community health service institutions 160 yuan; 400 yuan, a secondary community health service institution; 200 yuan, a first-class hospital; 440 yuan, a secondary hospital; 880 yuan, a tertiary hospital.
2) Minimum payment for residents' medical insurance: first-class community health service institution 100 yuan; 300 yuan, a secondary community health service institution; A hospital 100 yuan; 300 yuan, a secondary hospital; 800 yuan, a tertiary hospital.
For those who have been hospitalized for many times in one year, the deductible line will be reduced by 10% for each increase in the number of hospitalizations, and the lower limit of the deductible line for first-class hospitals will be 100 yuan; The lower limit of deductible for secondary hospitals is 260 yuan; The lower limit of deductible for tertiary hospitals is 620 yuan.
3, the basic medical insurance hospitalization reimbursement ratio. The proportion of medical reimbursement in different hospitals is different, and the proportion of reimbursement for employee medical insurance and resident medical insurance is also different. The proportion of medical insurance reimbursement for employees is the lowest 85% and the highest 95%; The minimum reimbursement rate for residents' medical insurance is 40%, and the maximum reimbursement rate is 80%.
4. Reimbursement for serious illness. The reimbursement standard for serious illness of employees is different from that of residents. Suffering from serious illness, the maximum reimbursement limit for employees is 500,000 per year, and the maximum reimbursement limit for residents is 200,000 per year.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.