Hangzhou employee medical insurance has implemented urban-rural integration, that is, employees and migrant workers enjoy the same treatment in medical insurance. In terms of specific reimbursement rates, Hangzhou has implemented the principle of "classification management and differential payment", setting different reimbursement rates for different medical items. Generally speaking, the reimbursement rate of HCM City employee medical insurance is between 70% and 90%. For example, for outpatient medical treatment, items such as western medicines, proprietary Chinese medicines, and checkups are eligible for 70% reimbursement, while ordinary hospitalization expenses are eligible for 80% reimbursement; and for special treatments, such as organ transplantation surgeries, and high-end medical equipment, 90% reimbursement is available. It should be noted that different medical programs also have different reimbursement limits and starting thresholds. For example, the reimbursement limit for outpatient western and proprietary Chinese medicines is RMB300/month, the reimbursement limit for outpatient examination is RMB200/times, and the starting line for inpatient medical treatment is RMB1,000/year. At the same time, the medical insurance also strictly controls medicines, and only medicines listed in the basic drug list or the national medical insurance drug list can be reimbursed by the medical insurance.
Are there any restrictions on the reimbursement of medical insurance for employees? Yes. According to the regulations of HCM City, there are some restrictions on the reimbursement of health insurance for employees. For example, employees are not allowed to enjoy other social insurance benefits while enjoying health insurance; employees must sign a family doctor service agreement in accordance with the requirements of the management of residents' health records in the process of implementing hierarchical diagnosis and treatment; at the same time, employees should comply with the relevant regulations when enjoying the treatment of medical treatment in other places.
The reimbursement rate of HCM City's employee health insurance ranges from 70-90 percent, with specific reimbursement rates, limits and starting payment lines set according to different medical programs. When enjoying health insurance reimbursement, employees need to abide by the relevant restrictions; at the same time, medicines also need to meet the relevant standards before they can be reimbursed by the health insurance.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China (PRC) stipulates that medical expenses that conform to the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.