In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a 2009 year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is 650 yuan. And the maximum payment amount of the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, for example, if he/she stays in a tertiary hospital, the employee pays 15%, or 85% of the expenses from the starting standard to 30,000 yuan; for the expenses from 30,000 yuan to 40,000 yuan, the employee pays 10%, and the reimbursement is 90%; and for the part of the expenses exceeding 40,000 yuan and up to the maximum payment limit, 95% of the expenses can be reimbursed, and the employee only has to pay 5%. In accordance with the "National Basic Medical Insurance Diagnosis and Treatment Program Scope", the details are as follows:
(a) Service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment expediting fee, surcharge for named surgery, quality premium fee, self-invited special nurses and other special medical services.
(2) Non-disease treatment program category. (1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height projects; (3) a variety of health checkups; (4) a variety of preventive, health care clinic programs; (5) a variety of medical consultation, medical appraisal.
(C) diagnostic and treatment equipment and medical materials. (1) the application of positron emission tomography (PET), electron beam cT, ophthalmic excimer laser therapy and other large-scale medical equipment for examination and treatment programs; (2) glasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, checking and treatment equipment; (4) the provincial pricing departments can not be charged separately for the disposable medical.
(4) treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valve, cornea skin, blood vessels, bone, bone marrow transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
Legal basis
The People's Republic of China Social Insurance Law
Article 27
Individuals who participate in the basic medical insurance for employees and reach the statutory retirement age when the cumulative contribution reaches the number of years stipulated by the state, will no longer pay the basic medical insurance premiums after retirement, and will be entitled to the basic medical insurance benefits in accordance with the provisions of the state; if the cumulative contribution reaches the number of years, the contributions can be paid up to the national regulations, and if it does not, the contributions can be paid up to the national regulations, and the contributions can be paid up to the national regulations. If they have not reached the state's prescribed limit, they can pay contributions until the state's prescribed limit.
Article 28
Medical expenses in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.