1. The reimbursement rate cap for employee basic medical insurance is usually 95%. The reimbursement rate of employee medical insurance is divided according to the actual medical expenses incurred by the insured person, usually the minimum reimbursement rate for hospitalization is 85%, and the maximum reimbursement rate is 95%. The reimbursement rates may vary slightly depending on the economic level of the region.
II.
What is the reimbursement scope of the employee medical insurance
The urban employee medical insurance mainly consists of two parts: the basic medical insurance and the supplementary medical insurance. Since each city has different reimbursement rules, there is no standardized rule on the scope of reimbursement for employee medical insurance, but the basic items and scope are similar.
The basic scope of reimbursement includes:
1, outpatient and emergency medical expenses;
2, expenses for purchasing medicines in designated retail pharmacies;
3, medical expenses for those who are hospitalized after emergency rescue and hospitalization within 7 days before hospitalization;
4, outpatient medical expenses for radiation and chemotherapy for malignant tumors, kidney dialysis, and anti-rejection medicines for renal transplantation;
5, outpatient medical expenses for the use of anti-rejection medicines for the use of malignant tumors, and the use of anti-rejection medicines for the use of malignant tumors. outpatient medical expenses for anti-rejection drugs after kidney transplantation.
However, the following items are not covered by the urban workers' medical insurance reimbursement:
1. Services: registration fee, out-of-hospital consultation fee, and cost of medical records.
2. Non-disease treatment items: various beauty and fitness programs as well as non-functional cosmetic and orthopedic surgeries.
3, diagnostic and therapeutic equipment and medical materials: such as large-scale medical equipment for examination and treatment programs.
4, treatment programs: such as gong therapy, music therapy, health care nutrition therapy, magnetic therapy and other auxiliary treatment programs.
5, other: a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs.
Legal basis
The Chinese People's **** and the State Social Insurance Law
Article 28 of the basic medical insurance drug catalog, diagnostic and therapeutic items, medical services and facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administrative organization with the medical institutions and drug business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance by insured persons.