The proportion of fees that individuals need to pay after medical insurance reimburses heart bypass surgery is as follows:

1. The minimum payment for heart bypass surgery in a tertiary hospital is 30,000 yuan, and the individual payment ratio is 15%. The reimbursement rate is 85%.

2. For expenses of 30,000 to 40,000 yuan, the personal payment ratio is reduced to 10%, and the reimbursement ratio is increased to 90%.

3. If the cost exceeds 40,000 yuan and reaches the maximum payment limit, the personal payment ratio is reduced to 5%, and the reimbursement ratio is 95%.

4. The personal payment ratio for retirees is 60% of that of active employees, and all expenses below the minimum payment standard are borne by the individual.

5. For the first time payment using basic medical insurance every year, the minimum payment amount is 1,300 yuan.

6. The minimum payment standard for hospitalization for the second time and subsequent times within the year is 650 yuan.

7. The maximum payment amount of the basic medical insurance pooling fund during the year is 70,000 yuan.

Medical insurance policy for heart bypass surgery:

1. Medical insurance reimbursement scope: including surgical fees, hospitalization fees, drug fees, etc., but the specific reimbursement ratio and scope vary by region and medical insurance policy It varies;

2. Medical insurance payment limits: Medical insurance departments in various places will set different payment limits, and the excess usually needs to be paid by the individual;

3. Self-pay items: Some high-end materials or special drugs may not be reimbursed by medical insurance and require full payment by individuals;

4. Deposit and cap lines: Medical insurance usually has a deductible and cap line, which is lower than the deductible. The cost above the cap and the cost above the cap must be borne by the individual;

5. Designated hospitals: Only surgeries performed in designated hospitals can enjoy medical insurance reimbursement;

6. Reimbursement process: Patients need to submit relevant materials to apply for reimbursement according to the prescribed process, including hospitalization records, expense lists, etc.

To sum up, after cardiac bypass surgery is reimbursed by medical insurance, the proportion of personal payment costs decreases as the cost increases. Surgery costs below 30,000 yuan in tertiary hospitals are fully paid out of pocket, and personal payment of 30,000 to 40,000 yuan is 10 %, and the maximum payment is 5% for those exceeding 40,000 yuan. Retirees enjoy lower payment ratios. The minimum payment for first use of medical insurance in the year is 1,300 yuan, and the minimum payment for re-hospitalization is 650 yuan. The maximum annual payment is 70,000 yuan.

Legal basis:

"Social Insurance Law of the People's Republic of China"

Article 28

Comply with basic medical care The insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.

Article 29

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit . The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.