1. Employee medical insurance reimbursement ratio
If the insured workers are still working, the medical expenses above Qifubiaozhun and below the maximum payment limit incurred in hospitalization shall be shared by the medical insurance fund and individuals. The proportion of personal commitment is 6% in the first-class hospital, 8% in the second-class hospital, and 10% in the third-class hospital. The personal commitment of retirees and employees who have worked for more than 30 years will be halved. In a natural year, the maximum payment limit of medical insurance fund is 50 thousand yuan; The maximum payment limit of medical assistance fund is 6.5438+0.7 million yuan.
2. The proportion of medical insurance reimbursement for retired employees
The medical expenses incurred by retired workers for medical treatment are above the deductible and below the maximum payment limit, which is in line with the hospitalization medical expenses paid by the basic medical insurance. Class A drugs and general medical expenses are paid by the on-the-job employee pooling fund, and the retirees pooling fund pays 90%; 75% of the cost of Class B drugs is paid by the overall fund; 70% of the cost of high-tech examination and treatment is paid by the overall fund.
3. Provisions on the use of employee medical insurance
The funds in the employee's personal medical insurance account shall not be used for other purposes, and can only be used for my medical and health expenses; The insured person's personal account can also be used to buy drugs and medical devices within the prescribed scope in designated retail pharmacies. In the future, the insured can buy all drugs with quasi-brand names and medical devices with brand names in designated retail pharmacies with social security cards.
Materials required for medical insurance reimbursement of the unit
1, original ID card or social security card;
2, the original certificate of disease diagnosis issued by the designated medical institutions;
3, outpatient medical records, inspection, test results report and other original medical information;
4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;
5. The detailed list of outpatient expenses printed by the hospital or the original payment of prescriptions issued by doctors;
6. Designated pharmacies: the original invoice and the sales list of tax commodities printed by * *;
7. If it is an agent, you need to provide the original ID card of the agent.
To sum up: the reimbursement ratio of unit medical insurance refers to the proportion of medical expenses borne by insurance companies, usually expressed as a percentage. The reimbursement ratio is stipulated in the insurance contract, which may be different due to different insurance plans and projects. Employees should know the reimbursement ratio, arrange medical expenses reasonably, and pay attention to the provisions and restrictions in the insurance contract.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.