85% of the retirees' hospitalization medical insurance qifubiaozhun above 5, yuan will be paid; 5 yuan to 1 yuan shall be paid at 9%.
reimbursement ratio of medical insurance:
1. Medical expenses for outpatient and emergency treatment: the part of the employees who meet the scope of the basic medical insurance within the year (from January 1 to December 31) has accumulated more than 2, yuan.
2. Settlement ratio: 5% of the part of the dispatched personnel over 2, yuan will be reimbursed during the contract period, and 5% will be paid by the individual; In a year, the maximum amount of accumulated reimbursement for dispatched personnel for outpatient and emergency services is 2, yuan.
3. Insured personnel should properly keep the outpatient medical documents (including receipts and prescriptions below a large amount) that are treated in designated hospitals as medical expense reimbursement vouchers.
4. Outpatient medical treatment for three kinds of special diseases: When the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person goes to see a doctor will issue a "disease diagnosis certificate", fill in the "Declaration and Approval Form for Special Diseases of Medical Insurance" and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals approved for treatment, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred meet the prescribed scope of outpatient special diseases, they shall be settled with reference to hospitalization.
The following items are not included in the reimbursement scope of medical insurance:
(1) 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, additional fees for roll call operation, high quality and good price, and self-invited special nurses.
(2) Non-disease treatment items.
(1) all kinds of beauty, bodybuilding and non-functional plastic surgery;
(2) various weight loss, weight gain and height increase projects;
(3) various physical examinations;
(4) various preventive and health care diagnosis and treatment projects;
(5) all kinds of medical consultation and medical appraisal.
(3) diagnosis and treatment equipment and medical materials.
(1) Examination and treatment items with large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic apparatus;
(2) Rehabilitation appliances such as glasses, dentures, artificial eyes, prostheses and hearing AIDS;
(3) all kinds of self-use health care, massage, examination and treatment equipment;
(4) One-time medical treatment that cannot be charged separately as stipulated by the provincial price departments.
(4) treatment items.
(1) the organ source or tissue source of various organ or tissue transplants;
(2) transplantation of organs or tissues other than kidneys, heart valves, corneal 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.
(5) others.
(1) diagnosis and treatment items of various infertility (pregnancy) and sexual dysfunction;
(2) all kinds of scientific research and clinical verification diagnosis and treatment projects.
Further reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.