After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses of more than 1800 yuan 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 an active employee spends $2,500 on an outpatient visit, then 50 percent of the $500 portion can be reimbursed, which is $250.
In the case of hospitalized expenses, the starting amount is $1,300 for the first time that basic medical insurance is used to pay for them in a year in 2009, for both active employees and retirees. 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%, which means 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, which means 90% reimbursement; for the portion of the expenses exceeding 40,000 yuan and up to the maximum payment limit, 95% of the expenses can be reimbursed, and the employee only has to pay 5%. And while retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, anything below the starting threshold is paid by the individual.
The diagnostic and therapeutic items that are not paid for by the employees' basic medical insurance are mainly those that are not clinically necessary, those whose effects are uncertain, and those 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 others such as infertility treatments, etc. In accordance with the National Basic Medical Insurance (NBMI), the employees' basic medical insurance will be reimbursed at the rate of 60% of the employees. 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 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 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 therapeutic 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 program;
(2) a variety of scientific research, clinical verification of the diagnosis and treatment program.