The new policy on the reimbursement ratio of medical insurance in 2022 is as follows:
1. Medical insurance is mainly divided into employee medical insurance and resident medical insurance, and the reimbursement ratios are also different;
2. The reimbursement ratio of employee medical insurance is divided according to the level of hospitalization expenses. The reimbursement ratio is 85% for those between 1,300 yuan and 30,000 yuan, 90% for those between 30,000 yuan and 40,000 yuan, and 90% for those between 40,000 yuan and 100,000 yuan. The reimbursement ratio is 95% for the amount of 10,000 yuan, and the reimbursement ratio for the amount between 100,000 and 300,000 yuan is 85%;
3. Residential medical insurance is composed of the urban residents’ medical insurance and the new rural cooperative medical insurance. The reimbursement ratio is 65% for first-level hospitals, with a minimum payment threshold of 300 yuan; the reimbursement ratio for second-level hospitals is 65% for less than 6,000 yuan, and 80% for more than 6,000 yuan. Among them, county second-level hospitals The minimum payment line is 400 yuan, and the minimum payment line for municipal second-level hospitals is 600 yuan, etc.
Medical insurance reimbursement ratio and scope:
1. Outpatient and emergency medical expenses: Medical treatment that meets the scope of basic medical insurance within the year (January 1st - December 31st) for active employees The total amount of fees exceeds 2,000 yuan.
2. Settlement ratio: During the contract period, the dispatched personnel will be reimbursed 50% for the amount of more than 2,000 yuan, and the individual will pay 50% out of pocket; the maximum amount of outpatient and emergency reimbursement paid to the dispatched personnel in one year is 20,000 yuan.
3. Insured persons must properly keep the outpatient medical receipts (including receipts for large amounts and below, the bottom of prescriptions, etc.) for medical treatment in designated hospitals as proof of medical expense reimbursement.
4. Outpatient medical treatment for three special diseases: when the insured person needs to seek medical treatment in an outpatient clinic after radiotherapy and chemotherapy for malignant tumors, renal dialysis, or kidney transplantation, the insured person shall The designated secondary and tertiary hospitals for medical treatment will issue a "Disease Diagnosis Certificate", fill out the "Medical Insurance Special Disease Application Approval Form", and report it to the district medical insurance center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are only available in designated hospitals approved for treatment, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred fall within the prescribed range for outpatient special diseases, they will be settled with reference to hospitalization.
5. Inpatient medical treatment: Only after paying for medical insurance for 20 years can you enjoy medical insurance reimbursement after retirement.
Legal Basis
"Social Insurance Law of the People's Republic of China"
Article 23: Employees shall participate in employee basic medical insurance, which shall be provided by the employer Units and employees must pay basic medical insurance premiums together in accordance with national regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.