The reimbursement rate is divided into several criteria depending on the level of the hospital and the amount of reimbursement. medical expenses above 1800 RMB are eligible for reimbursement, and the reimbursement rate is 50%. The standard of hospitalization reimbursement is related to the level of the hospital where the participant lives, such as a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement; 30,000 yuan to 4,000 yuan, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the maximum payment limit portion of the cost, then 95% of the cost can be reimbursed, and the employee only has to pay 5%. Retirees, on the other hand, pay 60 percent of what active employees pay individually, but anything below the threshold is paid by the individual.
Not covered by corporate health insurance:
Service items
1, registration fees, out-of-hospital consultation fees, and medical record cost.
2, consultation fee, examination and treatment expedited fee except emergency, surcharge for named surgery, quality and premium fee, self-invited special nurse fee and other special medical services.
Non-disease treatment program category
1, a variety of cosmetic life beauty, medical cosmetic fitness program and messy non-functional cosmetic surgery, orthopedic surgery and so on.
2, a variety of weight loss, fat, height projects.
3, a variety of health checkups.
4, a variety of prevention, health care treatment programs.
5, dental orthodontics, dental porcelain.
6, a variety of medical consultation does not include psychiatric consultation, medical appraisal.
Diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the inspection and treatment program.
2, eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative appliances.
3, a variety of self-use health care, massage, examination and rehabilitation and treatment equipment.
Therapeutic items category
1, all kinds of organ transplantation or tissue transplantation organ source or tissue source.
2. Organ or tissue transplants other than kidney, **valve, cornea, skin, blood vessel, bone, **transplantation.
3. Orthopedic surgery for myopia.
4, qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary treatment programs.
In summary, medical insurance also has two main insurance functions: risk transfer and compensation transfer. That is to say, the distribution of financial losses caused by individual risks of illness to all members threatened by the same risk, and the use of a centralized health insurance fund to compensate for the financial losses caused by illness.
Legal basis:
Article 30 of the Law of the People's Republic of China on Social Insurance
The following medical expenses are not included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid out of the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public **** Health to bear;
(iv) medical treatment outside the country.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.