The reimbursement rate for hospitalization under the employee health insurance is divided according to the level of hospitalization expenses:
1. The reimbursement rate for hospitalization between 1300 yuan and 30,000 yuan is 85%.
2. The reimbursement rate between thirty thousand dollars and forty thousand dollars is 90 percent.
3. The reimbursement rate between forty thousand dollars and one hundred thousand dollars is 95 percent.
4. The reimbursement rate between $100,000 and $300,000 is 85 percent.
The maximum payment limit is RMB150,000 per medical year.
Medical insurance, generally referred to as basic medical insurance, is a social insurance system established to compensate workers for financial losses caused by the risk of illness. A medical insurance fund is set up through contributions from employers and individuals, and medical insurance organizations provide certain financial compensation to insured persons after they incur medical expenses in the event of illness and consultation.
I. The basic scope of reimbursement of employee medical insurance includes:
1. medical expenses for outpatient and emergency treatment;
2. expenses for purchasing medicines from designated retail pharmacies;
3. medical expenses within 7 days of hospitalization for those who were hospitalized after emergency rescue and hospitalization;
4. medical expenses within 7 days of hospitalization for radiation and chemotherapy treatment of malignant tumors, dialysis, and anti-depressant after kidney transplantation;
5. medical expenses within 7 days of hospitalization for those who were hospitalized after emergency treatment. outpatient medical expenses for taking anti-rejection drugs after kidney dialysis and kidney transplantation.
The following items are not included in the reimbursement scope of urban workers' medical insurance:
1. Service items: 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, therapeutic 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
Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical services and facilities, as well as emergency and rescue medical expenses, in accordance with the state regulations, paid 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, so as to facilitate the enjoyment of basic medical insurance by insured persons.