The annual reimbursement limit for urban employee medical insurance outpatient clinics is 20,000 yuan.
1. The annual reimbursement limit for urban employee medical insurance outpatient services is 20,000 yuan. Deposit line: 1,800 yuan for current employees, reimbursement ratio: 70 yuan and up. 1,300 yuan for retirees, reimbursement ratio: starting from 85. Annual hospitalization reimbursement limit: 300,000 yuan. Deposit line: Regardless of current employees or retirees, the first hospitalization starts from 1,300 yuan, and the reimbursement rate starts from 85 yuan. Second hospitalization, starting from 650 yuan, reimbursement rate: 85 yuan. Major diseases: The portion of out-of-pocket medical expenses that exceeds the per capita disposable income of urban residents in this city in the previous year will be calculated in segments and paid cumulatively. If the amount is less than 50,000 yuan, the reimbursement rate is 50 yuan; if it is above 50,000 yuan, the reimbursement rate is 60 yuan, with no upper limit.
2. The annual reimbursement limit for outpatient medical insurance for urban and rural residents is 3,000 yuan. The minimum payment line: starting from 100 yuan for first-level hospitals, and the reimbursement ratio is 55. For second-level and above hospitals, the fee starts from 550 yuan, and the reimbursement ratio starts from 50 yuan. Hospitalization: 200,000 yuan. The minimum payment line: children start from 150 yuan, adults start from 300 yuan, and the reimbursement rate starts from 75 yuan. Note: The above expenses do not include expenses not included in medical insurance, such as out-of-pocket expenses and out-of-pocket expenses. Also, registration fees (medical service fees) are not included in the minimum payment line and cap line.
What is the reimbursement scope of employee medical insurance?
Urban employee medical insurance mainly consists of basic medical insurance and supplementary medical insurance. Since the reimbursement regulations of each city are different, there are no unified regulations on the reimbursement scope of employee medical insurance, but the basic items and scope are similar.
The basic scope includes:
1. Outpatient and emergency medical expenses;
2. The cost of purchasing medicines at designated retail pharmacies;
3. For emergency rescue patients who are kept under observation and admitted to hospital for treatment, the medical expenses for the 7 days of observation before hospitalization;
4. Radiotherapy and chemotherapy for malignant tumors, renal dialysis, and post-kidney transplantation services Outpatient medical costs of antirejection drugs.
However, the following items are not within the reimbursement scope of urban employee medical insurance:
1. Service items: registration fees, out-of-hospital consultation fees, medical record costs, etc.
2. Non-disease treatment items: various beauty and bodybuilding items, as well as non-functional plastic surgery, orthopedic surgery, etc.
3. Diagnostic and treatment equipment and medical materials: such as inspection and treatment projects for large medical equipment.
4. Treatment items: such as functional therapy, music therapy, health nutritional therapy, magnetic therapy and other auxiliary treatment items.
5. Others: diagnosis and treatment items for various infertility (pregnancy) diseases, sexual dysfunction, etc.
I hope the above content will be helpful to you. If you have any other questions, please consult a professional lawyer.
Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China"
Comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency, The medical expenses for rescue shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29
The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit .
The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.