Someone who spends a total of 25,000 yuan in medical expenses, and the reimbursement formula is like this: (25,000 - the starting line - out-of-pocket expenses) * 40%, if the out-of-pocket expenses account for a large proportion of the drug, its reimbursement is not much of an amount. (40% is a hypothetical value, easy to understand, the actual proportion in between in 30% ----75%, but according to your description is in the new bridge hospital, the hospital grade: the third class a, the proportion will not be too high, the first class starting line 1000, reimbursement rate of 30%; the second class starting line of 1000, reimbursement rate of 40%
Attached information
In 2009, all rural residents and urban residents will implement a unified cooperative medical policy and enjoy a unified standard of medical treatment. That is, the new rural cooperative medical care and urban residents' cooperative medical insurance will be operated in parallel, collectively known as urban and rural residents' cooperative medical insurance. The financing standards for urban and rural residents' cooperative medical insurance are divided into two grades, and the medical treatment is different according to the different grades of participation. The specific standards are as follows:
First class:
1, general outpatient reimbursement: urban and rural residents to implement outpatient co-ordination account management. The annual cumulative maximum limit is 25 yuan per person. Participants within the family can transfer the use of the account until it is exhausted.
2. Hospitalization reimbursement: the starting line for township (community) health centers is RMB 30, with a reimbursement rate of 65%; the starting line for central health centers is RMB 100, with a reimbursement rate of 60%; the starting line for county hospitals is RMB 200, with a reimbursement rate of 45%; the starting line for hospitals above the county level is RMB 1,000, with a reimbursement rate of 30%. The annual cumulative reimbursement limits are all 30,000 yuan per person per year.
Second class:
1. General outpatient reimbursement: urban and rural residents implement outpatient co-ordination account management. The annual cumulative maximum limit of 40 yuan per person. Participants within the family can transfer the use of the account until it is exhausted.
2. Hospitalization reimbursement: the starting line for township (community) health centers is RMB 30, with a reimbursement rate of 75%; the starting line for central health centers is RMB 100, with a reimbursement rate of 70%; the starting line for county hospitals is RMB 200, with a reimbursement rate of 55%; the starting line for hospitals above the county level is RMB 1,000, with a reimbursement rate of 40%. The annual cumulative reimbursement limits are both 30,000 yuan per adult per year and 72,000 yuan per minor per year.
3. Outpatient reimbursement for special diseases. The starting line is in accordance with the starting standard of county hospitals, and the outpatient limit is combined with the inpatient limit.
II. The term "off-site medical treatment" generally refers to medical treatment that occurs outside of the region where the person is participating in the medical insurance program. There is no clear legal definition of the term "out-of-town" in the context of social health insurance, "out-of-town" generally refers to domestic areas other than the coordinating area in which the participant is insured, Rongchang County is a municipal county in Chongqing, which is within the coordinating area of Chongqing, but I am not sure, I suggest that you consult with the hospital and the social security agency in Rongchang. The latter's statement, in particular, is authoritative)
Three. The factory's practice has violated the law, because as long as the factory once hired employees, they are required by law to pay for their social insurance, is mandatory insurance, according to the "Chinese People's Republic of China *** and the State Law on Social Insurance" Article 4 Chinese People's Republic of China *** and the territory of the employers and individuals pay social insurance premiums in accordance with the law, have the right to query the record of contributions, personal rights and interests record, and require social insurance agencies to provide social insurance consulting and other related services.
Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise the payment of contributions for them by their own units.
Your mother can file a complaint against the factory with the local social security department in Bishan, and ask the factory to make up for the outstanding social security contributions owed to your parents.
Pay attention to the collection of evidence, including the labor contract, time sheets, uniforms, meal cards, hand-operated bills, chest stickers, pictures of coworkers' dinners, pay stubs, and witness testimonies, and so on. The company's labor contract with the factory is a good example of how it can be used to make up for the loss.
2. If the labor contract does not stipulate that the factory must provide social security services to its employees, then you can argue with the factory according to the new Labor Law and fight for your mother's legal rights and interests.
3, if the factory is unreasonable, it is recommended to collect all the agreements signed by the factory and your mother and related evidence, to the local labor and social security departments to apply for arbitration, or the local trade union complaints, the odds are very large.
Four, report back to Rongchang to report
Supplement
Maybe the local saying is different, some places of the new rural cooperative medical drugs catalog, (later referred to as the "Drug Catalog"), the "Drug Catalog" in the western medicine and proprietary Chinese medicines are divided into A, B management, the use of "A directory" of drugs incurred costs, the cost of the drugs, according to the "A directory" of the "A directory" of drugs. The expenses incurred for the use of drugs in the "Class A Catalog" are paid in accordance with the provisions of the New Rural Cooperative Medical Scheme (NRCMS). Expenses incurred for the use of drugs in the "Class B Catalog" will be paid by the insured person at a certain percentage of his/her own expense, and then paid in accordance with the provisions of the New Rural Cooperative Medical Scheme. The specific percentage of out-of-pocket payment is determined by each coordinating region according to the fund's ability to pay and the individual's affordability.
Because the proportion is set by the local area according to its own economy and the co-ordination fund, a year a change. Specific information suggests that you consult the new rural cooperative medical care management office in Rongchang to determine