Beijing City Medical Insurance Reimbursement Expense Situation In Beijing, for example, the reimbursement of medical insurance expenses for urban workers and urban residents are shown in Tables 1 and 2, respectively. Table 1 Outpatient and hospitalization reimbursement of medical insurance for urban residents Annual starting line, reimbursement ratio and ceiling line Reimbursement category Participant category Only once in the year Starting line/$ Exceeding the starting line to the capped line portion Medical expenses reimbursement ratio (%) ceiling line/$ Outpatient expenses Student child 650502000 Urban unemployed resident 650502000 Urban senior citizen 650502000 Reimbursement category Participant category First starting line in the year/$ Starting line for the second time and each time thereafter during the year/$ Exceeding the starting line up to the capping line Part of the medical expenses reimbursement ratio (%) ceiling line/$ Inpatient expenses Students and children 6506507017 million Urban unemployed residents 13006507017 million Urban senior citizens 13006507017 million Table 2 Starting line, reimbursement ratio and ceiling line for outpatient and inpatient reimbursement of urban workers' medical insurance for the year Reimbursement category of participants Category of insured persons Starting line only once in the year/$ Reimbursement ratio for the portion of medical expenses exceeding the starting line up to the ceiling line (%) Reimbursement ratio for the ceiling line/$ Outpatient expenses In-service City community health service organizations 1800902 million Non-community health service organizations 70 Retirement Community health service organizations under 70 years of age 1300902 million Under 70 years of age Non-community health service organizations 85 Over 70 years of age 90 Reimbursement category Participant category First time within the year Starting line/$ Second time within the year and each time thereafter Starting line/$ Reimbursement level/$ Exceeding the Starting line to the cap line part of the medical expenses by level of reimbursement ratio (%) cap line / yuan Major Medical Mutual Aid Fund Payment Hospitalization expenses in-service 1300650 third-level hospitals second-level hospitals first-level hospitals reimbursement ratio (%) cap line / yuan Starting line - 30,000 85879010,000 85,220,000 30,000 to 40,000 909,295 40,000 - cap line 959797 Retirement 1300650 Level III Hospital Level II Hospital Level I Hospital 100,000 90 Starting line - 30,000 95.596.197 30,000 to 40,000 9797.698.5 40,000 --Capping line 98.599.199.1 Five types of items are not reimbursed Whether it is a medical consultation or hospitalization, health insurance is not reimbursed for some items, that is, for those who participate in the health insurance, what types of items are not reimbursed? Generally speaking, they are divided into five main categories: medical services class consultation fees, out-of-hospital consultation fees, registration fees, examination and treatment of expedited fees, medical records and other costs; named surgery surcharge, special nurses and other special medical services. Non-therapeutic disease programs Various fattening, weight loss, height enhancement programs; a variety of bodybuilding, cosmetic programs and non-functional cosmetic, orthopedic surgery, etc.; a variety of health care, preventive diagnostic and therapeutic programs; a variety of medical consulting, medical appraisal programs. Medical materials and diagnostic and therapeutic equipment Eye prostheses, prosthetic teeth, prosthetic limbs, hearing aids and other rehabilitative devices, the application of positron emission tomography devices, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program. All kinds of massage, health care, examination and treatment equipment for personal use. There are also disposable medical materials that are not subject to separate charges as stipulated by the price departments of various places. Therapeutic programs Music therapy, qigong therapy, health care nutritional therapy, magnetic therapy and other auxiliary therapeutic programs. Myopia Orthopedics; all kinds of organ or tissue transplants of organ source or tissue source, except for skin, heart valves, cornea, blood vessels, kidney, bone, bone marrow transplants. Others All kinds of clinically verified and scientific research treatment programs; all kinds of sexual dysfunction and infertility treatment programs. In addition, the medical insurance does not reimburse for emergency ambulance fees, baby warming box fees, food warming box fees, compensation for damages to public property, cleaning fees, nurse's fees, outpatient decoction fees, and other special living service fees. All of the above expenses incurred by the insured during medical treatment are not covered by health insurance and must be paid for by the insured.
Legal Objective:Article 25 of the Social Insurance Law of the People's Republic of China (PRC) states that the State shall establish and improve the basic medical insurance system for urban residents. Basic medical insurance for urban residents is a combination of individual contributions and government subsidies. The government shall subsidize the portion of individual contributions required by persons enjoying the minimum subsistence guarantee, persons with disabilities who have lost the ability to work, and elderly persons over the age of sixty and minors from low-income families. Article 28 of the Social Insurance Law of the People's Republic of China shall be paid out of the basic medical insurance fund in accordance with state regulations for medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards for medical service facilities, as well as those for emergencies and resuscitations.