Employee health insurance reimbursement ratio, in general, the economic development of different regions is different, so the reimbursement ratio also varies, the following on the situation of the ratio of Beijing employee health insurance insurance is explained.
The standard of hospitalization reimbursement is related to the level of the hospital in which the participant lives, such as living in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement; 30,000 yuan to 40,000 yuan, the employee pays 10%, reimbursement of 90%;
Over 40,000 yuan to the part of the maximum payment limit, 95% of the cost is reimbursed, the employee only need to pay 5%. Retirees, on the other hand, pay 60 percent of what an active (that is, the aforementioned) employee pays, but anything below the threshold is paid by the individual.
The diagnostic and therapeutic items that are not covered by the basic medical insurance for employees are mainly those that are not clinically necessary, those whose effects are uncertain, and those that require medical services;
These include services such as registration fees, non-disease treatment items such as beauty treatments, therapeutic equipment and medical materials such as hearing aids, and therapeutic items such as magnetic therapy, as well as other items such as infertility treatments.
Legal basis:
The General Office of the State Council on the comprehensive promotion of maternity insurance and employees' basic medical insurance merger and implementation of the views of the State Council
Second, the key tasks
(a) to clarify the scope of participation. The merger of the two insurance refers to the simultaneous participation in maternity insurance by active employees who participate in the basic medical insurance of employees in Shandong Province, and the unified registration of the insurance. If the medical insurance relationship and the maternity insurance relationship are not in the same coordinating area, when the merger is implemented, in principle, the maternity insurance will follow the medical insurance to participate in the payment.
(2) Defining the contribution ratio and contribution base. The new contribution ratio for the basic medical insurance for employees is determined by the sum of the contribution ratios for the maternity insurance and the basic medical insurance for employees of the employer. If the original contribution bases of the two insurances are inconsistent, the new contribution base shall be unified and approved according to the contribution base of the medical insurance. A mechanism for determining and adjusting the rates is established in accordance with the principle of balancing revenues and expenditures, based on the expenditures of the Employees' Basic Medical Insurance Fund and the demand for maternity treatment. The two types of insurance are unified in terms of collection and payment, and the funds are operated together at the same level of coordination. The income of the maternity insurance fund is no longer listed separately, and an expenditure item for maternity treatment is set up in the expenditure on treatment of the employees' basic medical insurance fund.
(3) Guaranteeing maternity insurance treatment. Employees enjoy maternity insurance treatment should be in line with the requirements of family planning policy, in accordance with the "Chinese People's *** and the State Social Insurance Law" provides for the payment of maternity medical expenses and maternity allowances, the required funds from the employees' basic medical insurance co-ordination fund. Maternity allowances for employees are paid in accordance with the relevant provisions of the Special Provisions on the Labor Protection of Female Employees and Workers, the Measures for the Labor Protection of Female Employees and Workers in Shandong Province, and the Regulations on Population and Family Planning in Shandong Province. Increased maternity leave and nursing leave are regarded as attendance, and wages are paid as usual, with no change in benefits. Maternity allowance is paid in accordance with the average monthly salary of employees of the employer in which the employee works in the previous year. Maternity allowance and wages are not duplicated. The unemployed spouse of a male employee participating in maternity insurance who has given birth in accordance with the provisions of the family planning policy and is not entitled to maternity medical treatment, shall be entitled to maternity allowance in accordance with 50% of the locally stipulated standard of the employee's maternity medical expenses.