Employee medical insurance is mandated by the state to implement, employees should participate in the basic medical insurance, by the employer and the employee in accordance with the state regulations *** with the payment of the basic medical insurance premiums, subject to the social insurance law and labor contract law. The reimbursement rate of the employee medical insurance is different from that of the new rural medical insurance and urban medical insurance, and generally speaking, the reimbursement rate of the employee medical insurance is higher.
I, the latest general reimbursement rate of employee health insurance
Hospitalization reimbursement rate is related to the level of the hospital in which the participant lives, such as living in a tertiary hospital, from the starting standard to the 30,000 yuan of costs, the employee pays 15%, or reimbursement of 85%; 30,000 yuan to 40,000 yuan of costs, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the maximum payment limit of part of the costs, then 95% can be reimbursed. expenses, then 95% are reimbursed and the employee pays only 5%. And while retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, anything below the threshold is paid by the individual.
The reimbursement rate varies from region to region. Take Beijing as an example
If you are an active employee, you can only be reimbursed for medical expenses above 1,800 yuan after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50 percent. In the case of retirees under the age of 70, expenses above $1,300 are reimbursed, and the reimbursement rate is 70 percent. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
The maximum limit for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50 percent of the $700 portion can be reimbursed, which is $350.
Three, the employee health insurance contribution rate
Basic medical insurance premiums are paid by both the employer and the employee***. The employer's contribution rate should be controlled at about 6% of the employee's gross salary, and the employee's contribution rate is generally 2% of his salary income. With economic development, the employer and employee contribution rate can be adjusted accordingly.
The reimbursement rate for employee health insurance varies depending on the level of hospitalization, and the reimbursement rate for employee health insurance is relatively high, usually reaching more than 80% of the reimbursement rate. However, it should be noted that some medical items are not reimbursable, such as registration fees, out-of-hospital consultation fees, medical records, or some diagnostic equipment and inspection costs.
Legal Objective:Article 23 of the Insurance Law of the People's Republic of China*** and the State Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums for the employer and the employees in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who have not participated in the basic medical insurance for employees in the employing organization, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.