1. Outpatient reimbursement ratio: Employees who are on the job can only be reimbursed for medical expenses of more than 2,000 yuan after seeing a doctor in the hospital, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.

Legal analysis: 1. Outpatient reimbursement ratio: if the employee is on the job, he can only reimburse medical expenses of more than 2,000 yuan after the emergency treatment in the hospital, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.

First, the scope of reimbursement of medical insurance for urban residents

The reimbursement scope of the basic medical insurance for urban residents mainly includes the following expenses incurred by the insured in designated medical institutions and retail pharmacies that are included in the reimbursement scope of the basic medical insurance fund for urban residents: hospitalization expenses; Medical expenses within 7 days before emergency observation and hospitalization; The medical expenses for special diseases in urban residents' outpatient clinics meet the requirements.

The second is the proportion of medical insurance reimbursement for urban residents.

Qifubiaozhun and reimbursement ratio of basic medical insurance for urban residents are determined according to the categories of insured persons.

1, students, children.

In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

2. Older people over 70 years old.

In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.

3. Other urban residents.

In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.

Legal basis: Article 16 of the Announcement on Public Solicitation of Medical Security Law.

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Going abroad for medical treatment;

(five) physical fitness, health care consumption, health examination;

(six) other expenses that are not paid by the basic medical insurance fund stipulated by the state. When it has a significant impact on economic and social development, the non-payment scope of the basic medical insurance fund can be temporarily adjusted through legal procedures. Seventeenth basic medical insurance insured in designated medical institutions in line with the basic medical insurance payment range of expenses, the basic medical insurance fund to pay in accordance with the provisions.