1, the reimbursement rate of medical insurance for urban residents in Xinjiang in primary medical institutions was adjusted from 60% to 75%;
2. On-the-job employees: outpatient service is exempted from 2,000 yuan, that is, the part exceeding 2,000 yuan of medical expenses incurred in outpatient service is reimbursed, and the reimbursement ratio is 50%;
3. Retired employees: the outpatient fee is 1.300 yuan, that is, only the part that exceeds 1.300 yuan is reimbursed, and the reimbursement rate is 70% for those under 70 years old and 80% for those over 70 years old;
4. General outpatient service: In a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund are reimbursed at the rate of 60%, and the annual maximum personal payment limit of the co-ordination fund is 400 yuan;
5. Special diseases: within a medical insurance year, the exemption amount of outpatient service for special diseases is 400 yuan, and the reimbursement ratio of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization;
6. The village clinic and the village center clinic will be reimbursed 60%, with the prescription drug fee limit of 10 yuan, and the prescription drug fee limit of temporary rehydration for residents is 50 yuan;
7. 40% reimbursement for medical treatment in town hospitals. The examination fee and operation fee for each visit are limited to 50 yuan, and the prescription fee is limited to 100 yuan. The reimbursement for medical treatment in secondary hospitals is 30%, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. Third-level hospitals will be reimbursed 20%, with the examination fee and operation fee for each visit limited to 50 yuan and prescription drug fee limited to 200 yuan.
Designate the insurance liability of outpatient drugs/hospitalization medical insurance expenses for rare diseases, and bear the liability for paying part of the drug expenses paid by individuals in designated hospitals and pharmacies within the agreed scope of insurance liability. The insured amount is 300,000 yuan, 12 kinds of drugs, and the insurance liability of outpatient specific high drug expenses is 20,000 yuan, and the reimbursement ratio is 70%.
To sum up, in a word, employees' medical insurance is jointly paid by employers and employees (employees' medical insurance for flexible employees is paid by individuals), and the main benefits of employees' medical insurance include outpatient treatment and hospitalization treatment.
Legal basis:
Article 2 of People's Republic of China (PRC) Insurance Law
The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.
essay
This Law is applicable to insurance activities in People's Republic of China (PRC).
Article 5
The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.