The Employee's Medical Insurance for Major Diseases is a special medical insurance fund established to protect the medical needs of urban workers for major diseases, and is used to pay for the medical expenses (excluding out-of-pocket expenses) incurred by insured persons participating in the basic medical insurance for urban workers that exceed the maximum payment limit of the basic medical insurance (40,000 yuan) within the annual accumulation of the insured person's medical expenses. Below I have prepared for you some of the relevant content of the Beijing employee's major medical insurance policy, I hope to help you!
What are the policies on medical insurance for major illnesses for Beijing workers
Units participating in medical insurance for major illnesses need to be in strict accordance with the "Provisions on the Social Integration of Medical Expenses for Major Illnesses of Urban Enterprise Workers and Retirees of Locally-Owned Cities and Towns of Beijing Municipalities" and related documents. The regulations are designed to ensure that enterprise workers and retirees who suffer from serious illnesses are provided with basic medical protection.
I. Scope of coverage: The regulations apply to enterprises (hereinafter referred to as enterprises) and their employees and retirees belonging to municipalities and districts and counties within the administrative area of Beijing.
Second, the standard of payment and the time of payment:
1. Units (excluding foreign-invested enterprises) shall pay a monthly fee of 6% of the average monthly salary of the employees in the city in the previous year, according to the number of active employees in the unit.
2, employees pay monthly medical insurance premiums according to 1% of the average monthly salary of employees in the city in the previous year, and the unit withholding;
3, according to the provisions of the document of the Beijing Labor Insurance [1998] No. 102 to participate in the medical insurance of major illnesses of the unit, are to be made up for the payment of major illnesses of the medical insurance premiums from July 1, 1998 onwards, July 1, 1998 after the establishment of units since the month of the issuance of the business license. Business license issued by the month to pay back the medical insurance premiums for major illnesses.
4. Foreign-invested enterprises shall pay monthly medical insurance premiums of 2.5% of the average monthly salary of the city's employees in the previous year, according to the number of Chinese employees in the enterprise. Individual employees and retirees pay a monthly fee of 1% of the average monthly salary of the city's employees in the previous year.
5. When the average monthly salary of an enterprise's employees is less than 10% or more of the average monthly salary of the city's employees, 90% of the average monthly salary of the city's employees shall be used as the base.
6, the unit must be before the 30th of each month to pay the full amount of the monthly medical insurance premiums for major diseases, shall not be interrupted by the employee's major medical insurance coverage of the employee's major medical insurance coverage.
Third, the payment standard and reimbursement scope of the integrated fund for major diseases: employees who are sick, not due to work-related injuries, one-time hospitalization of medical expenses or within 30 days of the cumulative total of more than 2,000 yuan or more of the portion of the (excluding out-of-pocket expenses, the individual portion of the burden) belongs to the scope of payment of the integrated fund for major diseases, to take the calculation of the grades, the cumulative payment method:
1, more than 2,000 yuan 5,000 yuan 90% of the portion below 5,000 yuan;
2. 85% of the portion above 5,000 yuan and below 10,000 yuan;
3. 80% of the portion above 10,000 yuan and below 30,000 yuan;
4. 85% of the portion above 30,000 yuan and below 50,000 yuan;
5. 90% of the portion above 50,000 yuan.
D. Medical expenses incurred under any of the following circumstances are not covered by the medical insurance for major illnesses:
1. Unauthorized treatment in non-scheduled hospitals (except for emergency resuscitation);
2. Occupational diseases, injuries sustained on the job, or the recurrence of old illnesses resulting from work-related injuries;
3. Injuries caused by traffic accidents;
4. Injuries caused by one's own violation of the law;
5.
5, food poisoning caused by a responsible accident;
6, suicide resulting in treatment;
7, injuries caused by medical malpractice;
8, according to the state and municipal regulations of the medical expenses should be self-care.
The new policy stipulates that since January 1, 2017, the annual maximum payment limit of the medical aid for major illnesses under the urban workers' health insurance of Beijing has been raised from 300,000 yuan to 400,000 yuan, and the scope and proportion of the payment of the medical aid for major illnesses will remain unchanged. The medical aid for major illnesses will be paid at a 90% ratio, and the major illness medical insurance will pay at a 90% ratio if you are transferred to a different place for treatment. For the health insurance reimbursement strategy, I just happened to organize the relevant content, I hope to help you: social security health insurance how to use? An article to teach you to apply for the reimbursement process!
That is to say, the insured person in a natural year in line with the basic medical insurance to pay for the scope of medical expenses, the cumulative total of more than the maximum payment limit of the integrated fund of more than 60,000 yuan to a maximum of 400,000 yuan portion of the relief fund to pay for 90%, the proportion of individual out-of-pocket payment of 10% employee major medical insurance scope of the article employee's major diseases In addition, the urban workers' health insurance medical aid for the major illnesses of the contributions The amount remains unchanged.
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2017 employee medical insurance contribution ratio?
There are three key data for medical insurance reimbursement in 2017, one is the starting standard, another is the reimbursement ratio, and the last is the reimbursement limit, and the scope of reimbursement can be divided into four categories, which are the category of services, non-disease treatment items, diagnostic and therapeutic equipment and medical materials, and therapeutic items, which are subject to different regulations for different situations. So what is the situation of employee health insurance contributions in 2017? The following is my collection of 2017 employee health insurance contribution ratio, welcome to read reference!