Reimbursement ratio of employee health insurance
Reimbursement scope: the insured person in the individual choice of health insurance designated hospitals or specialist hospitals, Chinese medicine hospitals and hospitals in category A hospitalization costs;
Reimbursement ratio: a natural year for the first hospitalization of the starting standard of 1300 yuan, and 650 yuan each time thereafter. The payment rate is divided into three grades, with the starting standard for a tertiary hospital, for example: 30,000 yuan, 85% for in-service and 91% for retired, 30,000-40,000 90% for in-service and 94% for retired, and more than 40,000 yuan, 95% for in-service and 97% for retired. General hospitalization 90 days as a billing cycle. 360 days for psychiatric hospitalization is a billing cycle, and the starting and ending standards are halved. Maximum payment of 70,000 yuan from the integrated fund in one natural year. The maximum payment for hospitalized large amount is 100,000 yuan, and the payment ratio for hospitalized large amount is always 70%;
Management of medical treatment: If the unit pays the fee in full, the individual only needs to pay a part of the hospitalization prepayment for hospitalization procedures. The medical expenses incurred should be in line with the scope of the three major directory libraries of medical insurance;
Reimbursement process: when discharged from the hospital, the hospital and the individual to clear the amount of out-of-pocket expenses and deductible portion of the reimbursement of the integrated fund by the hospital and the district health insurance center.
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