1, the proportion of employees' contributions is: 93% in community health centers, 88% in first-class hospitals, 86% in second-class hospitals and 84% in third-class hospitals;
2. Retirees pay 96.5% in community health centers, 94% in first-class hospitals, 93% in second-class hospitals and 92% in third-class hospitals;
3. Medical insurance for serious illness can be reimbursed for 90,000-200,000 yuan: 95% for large medical assistance and 5% for individuals.
According to the relevant laws and regulations, retired employees can reach the cumulative payment period stipulated by the state after the statutory retirement age, and they can enjoy the relevant treatment of basic medical insurance according to the state regulations without paying the basic medical expenses after retirement. The reimbursement rate in each region may be different, which is determined according to the reimbursement rate in each region.
There is no special provision for teachers' medical insurance reimbursement by law, so the deductible line of hospitalization medical insurance reimbursement ratio is 1300 yuan. If the second hospitalization is halved, it will be calculated according to 650 yuan. The reimbursement ratio is as follows: 85% for reimbursement below RMB 30,000, 90% for reimbursement between RMB 30,000 and RMB 40,000, and 95% for reimbursement above RMB 40,000. The maximum payment amount of the basic medical insurance pooling fund within one year (hospitalization expenses) is currently 70,000 yuan.
The reimbursement rate of teachers' medical insurance is as follows: 1. The proportion of reimbursement for outpatient expenses of on-the-job personnel (calculated by combining medical expenses on and off campus in the current year) is less than or equal to 3,000 yuan, with 80% of reimbursement for public medical expenses and 20% of personal burden; More than 3000 yuan, 90% of medical expenses reimbursement, personal burden10%; 2. The reimbursement rate of in-service staff's hospitalization expenses (within the year) is less than or equal to 1 10,000 yuan, of which 90% is reimbursed for medical expenses at public expense and the personal burden is10%; /kloc-more than 0/0000 yuan, 94% of medical expenses are reimbursed, and the personal burden is 6%.
Retired teachers' hospitalization expenses are reimbursed as follows:
1. About 90% of teachers who retire from financially funded institutions are reimbursed by medical insurance and settled in one lump sum with social security cards;
2. The school will apply for reimbursement after discharge. The school will reimburse 50%, and I will pay about 50% of the expenses.
The basic insurance does not pay the cost of the diagnosis and treatment project scope is as follows:
I. Service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.
Two, non-disease treatment projects are as follows:
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects.
Three, diagnosis and treatment equipment and medical materials are as follows:
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
Four, the treatment project is as follows:
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
Verb (short for verb) Other:
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects.
legal ground
People's Republic of China (PRC) social insurance law
second
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
Article 23
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Article 26
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.