Generally speaking, the economic development of different regions is different, so the reimbursement rate also varies, the following on the Beijing employee health insurance insurance ratio situation is explained.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1800 RMB after visiting the outpatient and emergency clinics 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. [4]
In the case of hospitalization expenses, the starting amount is 1,300 yuan 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 amount of payment from 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 category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment expediting fee, surcharge for named surgery, quality and premium fee, self-invited special nurse and other special medical services.
(2) Non-disease treatment program category. (1) a variety of cosmetic, bodybuilding and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height increase program. (3) a variety of health checkups; (4) a variety of preventive, health care treatment programs; (5) a variety of medical consultation, medical appraisal.
(C) diagnostic equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy and other large medical equipment for examination and treatment programs; (2) glasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical.
(D) treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
(v) 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.