1. Only medical expenses over 2000 yuan can be reimbursed, and the reimbursement rate is 50%;
2. If the retiree is under 70 years old, expenses over 1300 yuan can be reimbursed, and the reimbursement rate is 70%;
3. Expenses above $1300 can be reimbursed the reimbursement rate is 80%.
And regardless of the category, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan.
The scope of reimbursement for employee medical insurance is as follows:
The basic scope includes:
1, outpatient and emergency medical expenses;
2, the cost of purchasing medicines from designated retail pharmacies;
3, medical expenses for those who are rescued from emergency medical treatment and retained and admitted into inpatient hospitalization within 7 days of their pre-hospitalization retention;
4, malignant tumors Radiotherapy and chemotherapy, renal dialysis, outpatient medical expenses for taking anti-rejection drugs after renal transplantation.
However, the following items are not covered by the urban workers' medical insurance:
1. Services: registration fees, out-of-hospital consultation fees, and costs of medical records;
2. Non-disease treatment items: a variety of cosmetic and body-building items, as well as non-functional cosmetic and orthopedic surgeries;
3. Diagnostic and therapeutic equipment and medical materials: for example, examination and treatment items performed by large-scale medical equipment;
4.
3, diagnostic and therapeutic equipment and medical materials: such as large-scale medical equipment for examination, treatment programs;
4, treatment programs: such as homeopathy, music therapy, health care nutritional therapy, magnetic therapy and other auxiliary treatment programs;
5, other: a variety of infertility, sexual dysfunction diagnostic and therapeutic programs, and so on.
Legal Basis: Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and resuscitations, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.