The large amount of medical insurance is to solve the insured person due to the big disease, serious illnesses arising from the medical expenses (more than the basic medical insurance fund within the scope of the maximum payment limit of medical expenses) in the basic medical insurance basis, medical insurance municipal coordination to establish a large amount of medical insurance system. So, how is the large medical insurance reimbursement regulations? Specifically we still look at the following brief introduction. For the health insurance reimbursement strategy, I happen to have organized 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!
What are the rules for reimbursement of large medical insurance?
Large medical insurance is paid by the employer and the individual **** together. The employer will pay 1% of the sum of all employees' contributory wages, of which employees and retirees will pay 3 yuan per month (the amount of contribution varies according to local policies). The reimbursement of medical insurance for major illnesses is generally in line with the basic medical insurance provisions under the premise of the following methods of payment, as follows:
1, employees in an annual outpatient, emergency medical expenses exceeding a cumulative total of 2,000 yuan of the part of the large medical expenses of mutual aid funds can be paid 50%, the individual needs to bear 50%.
2. For retirees who have incurred outpatient and emergency medical expenses totaling more than 1,300 yuan in a year, 70% of the large medical expenses can be paid by the mutual funds for retirees who are under 70 years of age, while individuals need to bear 30%; for retirees who are over 70 years of age, the large medical expenses can be paid by the mutual funds for retirees at 80%, while individuals need to pay 20%.
3. In one year, the maximum amount of outpatient and emergency medical expenses paid by the large medical expenses mutual aid fund for employees and retirees is 20,000 yuan.
4. In one year, for hospitalization medical expenses incurred by employees and retirees that exceed the maximum payment limit of the Basic Medical Insurance Coordination Fund, the Large Medical Expenses Mutual Aid Funds can cover 70% of the expenses, and individuals need to bear 30% of the expenses.
In summary, the reimbursement of large medical insurance must be in accordance with the premise of the basic medical insurance regulations, according to the different medical expenses incurred, its reimbursement rate will also be different. This is the end of the above introduction, I hope it can help you.