1. Individuals can only pay for medical insurance and pension insurance;
Companies pay for pension insurance, medical insurance, work injury insurance, unemployment insurance and maternity insurance.
2. Individuals pay all the insurance costs borne by individuals;
Companies pay insurance costs borne by the company and individuals **** the same:
Pension insurance, the enterprise bears 20%, the individual bears 8%;
Medical insurance, the enterprise bears 7.5%, the individual bears 2%;
Unemployment insurance, the enterprise bears 2%, the individual bears 1%;
Workers' compensation insurance, enterprises bear all 1%;
Maternity insurance, enterprises bear all 0.8%.
3. The reimbursement rates of medical insurance are different:
A. The starting standard and reimbursement rate of basic medical insurance for urban residents are determined according to the categories of insured persons.
First, students and children. For medical expenses under 180,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for tertiary hospitals is 500 RMB, and the reimbursement rate is 55%; for secondary hospitals, the starting standard is 300 RMB, and the reimbursement rate is 60%; for primary hospitals, there is no starting standard, and the reimbursement rate is 65%.
The second is for the elderly who have reached the age of 70 or above. For medical expenses under 100,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for Level 3 hospitals is 500 RMB, and the reimbursement rate is 50%; the starting standard for Level 2 hospitals is 300 RMB, and the reimbursement rate is 60%; and Level 1 hospitals do not set a starting standard, and the reimbursement rate is 65%.
Third, other urban residents. In a billing year, the medical expenses of less than 100,000 yuan that meet the scope of reimbursement, the starting standard for third-level hospitals is 500 yuan, and the reimbursement rate is 50%; the starting standard for hospitalization in second-level hospitals is 300 yuan, and the reimbursement rate is 55%; and first-level hospitals don't have a starting standard, and the reimbursement rate is 60%.
Urban residents who are hospitalized for more than two times in one billing year will no longer be charged for the starting standard from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, they shall make up the difference in accordance with the prescribed starting standard for transferring to or re-admitting to the hospital.
B. Employee health insurance reimbursement rate
Generally speaking, the economic development of different regions varies, so the reimbursement rate also varies, the following on the situation of the ratio of employee health insurance coverage in Beijing.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses of more than 1800 RMB after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and you spend $2,500 on an outpatient visit, you can be reimbursed 50 percent of the $500 portion, which is $250.
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, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, that is, 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, and 90% reimbursement; more than 40,000 yuan to the part of the maximum payment limit, it is 95% reimbursement, and the employee only has to pay 5%. And retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, but anything below the starting level is paid by the individual.
The diagnostic and therapeutic items that are not paid for by the basic medical insurance for employees are mainly non-clinically necessary and uncertain diagnostic and therapeutic items as well as diagnostic and therapeutic items for special medical services, including services such as registration fees, non-disease treatments such as cosmetic treatments, therapeutic equipment and materials such as hearing aids, therapeutic items such as magnetic therapy, and other categories such as infertility treatments, and so on. In accordance with the "National Basic Medical Insurance Treatment Program Scope", as follows:
(a) service program category.
(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.;
(2) visit fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, self-invited special nurses and other special medical services.
(2) The category of non-disease treatment programs.
(1) a variety of beauty, fitness programs and non-functional cosmetic, orthopedic surgery;
(2) a variety of weight loss, weight gain, height increase program.
(3) Health checkups;
(4) Preventive and health care programs;
(5) Medical consultations and appraisals.
(3) Diagnostic and treatment equipment and medical materials.
(1) application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program;
(2) glasses, denture, eye prosthesis, prosthetic, prosthetics, hearing aids and other rehabilitative appliances;
(3) all kinds of self-use of health care, massage, checking and treatment equipment;
(4) disposable medical devices that are not separately chargeable by the price department of each province.
(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 of other organs or tissue transplantation;
(3) myopic orthopaedics;
(4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
(5) Others.
(1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
(2) a variety of scientific research, clinical verification of diagnosis and treatment programs.
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