Generally speaking, the economic development situation in different regions is different, so the reimbursement ratio is also different. The following is an explanation of the insurance ratio of Beijing employee medical insurance. If you are an active employee, only medical expenses above 1,800 yuan can be reimbursed after going to the hospital's outpatient clinic or emergency department, and the reimbursement rate is 50%. For retirees under the age of 70, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, 80% of expenses above 1,300 yuan can be reimbursed.
1. How to reimburse medical insurance
Generally speaking, the economic development conditions of different regions are different, so the reimbursement ratios are also different. The following is an explanation of the insurance ratio of Beijing employee medical insurance.
After enrolling in medical insurance, if you are an active employee, you can only reimburse for medical expenses of more than 1,800 yuan after going to the hospital's outpatient department or emergency department, and the reimbursement rate is 50%. For retirees under the age of 70, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, 80% of expenses above 1,300 yuan can be reimbursed.
No matter what type of person, the maximum amount of large-amount medical expenses paid for outpatient and emergency services is 20,000 yuan. For example, if you are an active employee and the cost of outpatient treatment is 2,500 yuan, then 50% of the 700 yuan part can be reimbursed, which is 350 yuan.
If it is hospitalization expenses, when the basic medical insurance is used for payment for the first time in 2009, the minimum payment amount is 1,300 yuan for both employees and retirees. For medical expenses for the second and subsequent hospitalizations, the minimum payment standard is determined at 50%, which is 650 yuan. The maximum payment amount of the basic medical insurance pooling fund (hospitalization expenses) in one year is 70,000 yuan.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person lives. For example, if the insured person lives in a third-level hospital, the employee pays 15% of the cost from the minimum payment standard to 30,000 yuan, which is 85% of the reimbursement. %; for expenses ranging from 30,000 yuan to 40,000 yuan, employees pay 10% and 90% is reimbursed; for expenses exceeding 40,000 yuan up to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. The proportion of personal payment for retirees is 60% of that of active (the above-mentioned) employees, but anything below the minimum payment standard is paid by the individual.
The diagnosis and treatment items that are not covered by the basic medical insurance for employees are mainly those that are not clinically necessary and have uncertain effects, as well as those that require special medical services, including service items such as registration fees, non-diseases, etc. Treatment items include beauty, etc., treatment equipment and medical materials such as hearing aids, etc., treatment items include magnet therapy, etc., and other categories such as infertility treatment, etc.
2. What is reimbursement
It means to report the items that have been used and discarded for write-off. It also means to list the receivables or income and expenditure accounts and submit them to superiors for write-off.
Legal basis:
"Scope of Diagnosis and Treatment Items of National Basic Medical Insurance", details are as follows:
(1) Service item category. (1) Registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) Consultation fee, expedited examination and treatment fee, roll call surgery surcharge, high-quality and low-price fee, self-recruitment of special nurses and other special medical services.
(2) Non-disease treatment items. (1) Various beauty and bodybuilding items, as well as non-functional plastic surgery, orthopedic surgeries, etc.; (2) Various weight loss, fattening, and height-increasing items; (3) Various health examinations; (4) Various prevention and health care Diagnosis and treatment items; (5) Various medical consultations and medical appraisals.
(3) Diagnostic and treatment equipment and medical materials. (1) Examination and treatment projects using large-scale medical equipment such as positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy equipment; (2) Rehabilitation of glasses, dentures, eyes, prostheses, hearing aids, etc. Sexual appliances; (3) Various health care, massage, examination and treatment equipment for self-use; (4) One-time medical use that cannot be charged separately according to the price departments of various provinces.
(4) Treatment items. (1) Organ sources or tissue sources for various types of organ or tissue transplantation; (2) Transplantation of other organs or tissues except kidney, heart valve, corneal skin, blood vessel, bone, and bone marrow transplantation; (3) Myopia orthopedics; (4) Qigong therapy, music therapy, health-related nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others. (1) Various diagnosis and treatment items for infertility (pregnancy) and sexual dysfunction; (2) Various scientific research and clinically verified diagnosis and treatment items.