1, the proportion of outpatient reimbursement: there is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service.

2. Hospitalization reimbursement ratio: The longer the continuous insured period, the greater the reimbursement ratio. For every five years of continuous payment by insured residents, the hospitalization reimbursement ratio of the medical insurance fund will increase by 5 percentage points, and the cumulative reimbursement ratio will not exceed 10 percentage point.

3. Proportion of second reimbursement: There may be "second reimbursement" after the "second reimbursement". Among the medical expenses incurred by insured residents in a single hospitalization, the part is within the scope of payment by the urban residents' basic medical insurance co-ordination fund. After the basic medical insurance co-ordination fund pays in proportion, the part whose personal burden exceeds 8,000 yuan will be "second reimbursement" by the serious illness insurance fund at a rate of 55%.

The reimbursement process of medical insurance in different places in Jiangxi is as follows:

1, download the "Application Form for People Working and Living in Different Places of Municipal Basic Medical Insurance" (hereinafter referred to as the "Application Form") on the social security website;

2, according to the provisions of the fill in, and by the foreign social insurance (medical insurance) agencies stamped "declaration form";

3. Take the completed "Declaration Form" back to the social insurance agency responsible for the division of labor for review and confirmation. If you need to apply for a medical card in different places in the province, you should register with the Audit Department of the Municipal Social Security Center on the basis of the "Declaration Form" after examination and confirmation, and then go to the Social Security Card Management Department to handle the card-making procedures of the remote networking card in the province;

4. After filing, the personal social security card of the insured can no longer be used; If the insured person returns to seek medical treatment, he/she should go to the municipal social security institution to cancel the medical registration, and his/her personal social security card can be used in the designated medical institution from the next day;

5. The principle of reporting changes and not reporting changes shall be implemented.

To sum up, the reimbursement rate of medical insurance in different places in Jiangxi Province is 88% for threshold fees above 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10000 yuan, and 95% for those above10000 yuan within the maximum payment limit. The maximum medical insurance for residents is 50%, and the maximum medical insurance for employees is 80%.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.

Article 29

The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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, so as to facilitate the insured to enjoy the basic medical insurance benefits.