Generally speaking, the economic development in different regions is different, so the proportion of medical insurance reimbursement is different. The following is an explanation of the proportion of employees' medical insurance in Beijing.
1. After receiving medical insurance, if they are on-the-job employees, they can only reimburse medical expenses above 1800 yuan after seeing a doctor in the emergency department of the hospital, and the reimbursement ratio is 50%. For retirees under the age of 70, 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.
2. No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20,000 yuan. For example, if an on-the-job worker spends 2,500 yuan in outpatient service, then 500 yuan can reimburse 50%, that is, 250 yuan. If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 yuan.
3. The standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the minimum threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.
4. The medical treatment items that employees' basic medical insurance does not pay are mainly those that are not necessary in clinic and whose curative effect is uncertain, as well as those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other categories such as infertility treatment. According to the national basic medical insurance diagnosis and treatment project scope.