Employee health insurance reimbursement ratio varies according to the level of economic development of different provinces and cities, the specific reimbursement ratio of how much to be determined according to the local policy provisions, in Beijing, for example, more than 1800 yuan of medical expenses can be reimbursed, the reimbursement rate is 50%. In the case of retirees under the age of 70, expenses above 1,300 yuan can also be reimbursed.
Legal Objective:Medical insurance is a kind of insurance to compensate for medical expenses caused by illness. It is a social insurance that provides necessary medical services or material help by the society or enterprises when an employee suffers from illness, injury or maternity. Such as China's public medical care and labor insurance medical care. The medical expenses of Chinese workers are borne by the state, the organization and the individual **** together, in order to reduce the burden on enterprises and avoid waste. The scope of medical insurance is very wide, and medical expenses are generally differentiated according to the characteristics of their medical services, which mainly include doctors' outpatient expenses, medicine, hospitalization, nursing care, hospital miscellaneous expenses, surgical expenses, and various examination expenses. Medical expenses are the costs incurred by the patient for treatment, which include not only the doctor's medical and surgical fees, but also the costs of hospitalization, nursing care, and hospital equipment. The reimbursement ratio and scope of medical insurance: 1. Outpatient and emergency medical expenses: the accumulated medical expenses in line with the scope of basic medical insurance within the year of the active employee (January 1~December 31) are more than 2,000 yuan or more. 2. Settlement ratio: 50% reimbursement of the part of the dispatched personnel over 2,000 yuan during the contract period, and the individual pays 50% out of his own pocket; the accumulated payment of the dispatched personnel's outpatient and emergency medical expenses in a year is 30,000 yuan. The maximum amount of reimbursement is 20,000 yuan. 3, the insured person should properly keep the outpatient medical bills (including receipts, prescription bottoms, etc.) of the outpatient treatment in the designated hospitals as the vouchers for reimbursement of medical expenses. 4, the outpatient treatment of three kinds of special illnesses: the insured person who suffers from malignant tumors radiation therapy and chemotherapy, renal dialysis, and antirejection medication after renal transplantation need to be treated in the outpatient clinics, the second or third level designated hospitals for medical treatment issued a certificate of "outpatient medical treatment for malignant tumors" by the insured person, Third-level designated hospitals to issue a "diagnostic certificate of disease", and fill out the "Medical Insurance Special Disease Declaration and Approval Form", reported to the District Medical Insurance Center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are in line with the scope of outpatient special diseases, they will be settled with reference to hospitalization.5. For inpatient medical treatment, the medical insurance payment is enough for 20 years before you can enjoy the medical insurance reimbursement after retirement. Rural Cooperative Medical Insurance Reimbursement Ratio and Scope: 1. Outpatient Reimbursement: (1) 60% reimbursement for visits to village health centers and village central health centers, with a limit of 10 yuan for prescription drug costs per visit, and a limit of 50 yuan for temporary rehydration of prescription drug costs by doctors of health centers. (2) 40% reimbursement for visits to township health centers, with a limit of RMB 50 per visit for various examinations and surgical procedures, and a limit of RMB 100 for prescription drugs. (3) 30% reimbursement for secondary hospitals, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs. (4) 20% reimbursement for tertiary hospital visits, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs per visit. (5) Chinese medicine invoice with prescription attached is limited to $1 per sticker. (6) Township cooperative medical outpatient compensation annual limit of 5,000 yuan. 2, hospitalization compensation (1) reimbursement scope: A, medicine: auxiliary examination: electrocardiogram, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic *** vibration of the limit of 200 yuan of each examination fee; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan). B, the elderly aged 60 years old or older in the hospitalized in Xingta Township Health Center, treatment and nursing fees are reimbursed at RMB 10 per day, with a limit of RMB 200. (2) reimbursement ratio: town health center reimbursement of 60%; secondary hospital reimbursement of 40%. 3, compensation for major illnesses town risk fund reimbursement: all participate in the cooperative medical treatment of hospitalized patients with a one-time or yearly cumulative reimbursable medical expenses exceeding 5,000 yuan or more segmented compensation, that is, 5,001-10,000 yuan reimbursement of 65%, 10,001-18,000 yuan reimbursement of 70%.