Proportion of hospitalization reimbursement of medical insurance for employees in Huizhou city

The reimbursement rate of hospitalization expenses of Huizhou employees is 95% or 50%; The reimbursement rate of outpatient expenses is 80% in first-class hospitals, 60% in second-class hospitals and 55% in third-class hospitals. In addition, the longer employees pay, the higher the proportion of medical insurance reimbursement.

Outpatient reimbursement ratio is as follows:

Medical insurance for employees: 80% in first-class hospitals, 60% in second-class hospitals and 55% in third-class hospitals;

The first grade of residents' medical insurance: 55% for first-class hospitals and 40% for second-and third-class hospitals (single limit: 30 yuan);

B file of residents' medical insurance: 75% for first-class hospitals and 40% for second-and third-class hospitals (one-time limit: 60 yuan).

The proportion of hospitalization reimbursement is as follows:

Employee medical insurance: 95% (continuous payment for more than 6 months) or 50% (continuous payment for less than 6 months);

Supplementary medical insurance: 95%;

The first grade of residents' medical insurance: 95% in first-class hospitals, 75% in second-class hospitals and 65% in third-class hospitals;

B file of residents' medical insurance: 95% in first-class hospitals, 85% in second-class hospitals and 75% in third-class hospitals.

Specific outpatient reimbursement ratio: medical insurance for employees: 95% of the medical expenses that meet the requirements after continuous payment for 6 months (excluding 6 months), and 50% of the medical expenses that meet the requirements after enrollment for less than 6 months (including 6 months). Hypertension and diabetes can only be applied after 202 1 1 day.

legal ground

Measures of Huizhou Municipality on Social Basic Medical Insurance

Article 8 Organs, institutions, social organizations, enterprises, private non-enterprise units, individual industrial and commercial households and other organizations (hereinafter referred to as employing units) within the administrative area of this Municipality shall, in accordance with the principle of territorial management, participate in medical insurance for all employees (including foreigners and Hong Kong, Macao and Taiwan personnel recruited according to law). Employers and non-military employees of the armed forces and armed police forces with non-military employees may participate in employee medical insurance in accordance with these measures. Individual industrial and commercial households without employees, part-time employees who have not participated in employee medical insurance in the employing unit, Hong Kong, Macao and Taiwan residents who are employed flexibly in this Municipality and apply for residence permits for Hong Kong, Macao and Taiwan residents, and other flexible employees may participate in employee medical insurance in accordance with these measures. Other units and personnel stipulated by laws, regulations and rules shall participate in employee medical insurance in accordance with relevant regulations.

Article 12 Medical insurance premiums and maternity insurance premiums for employees shall be collected together and managed in a unified way. Participate in employee medical insurance (including comprehensive basic medical insurance, hospitalization basic medical insurance and supplementary medical insurance, hereinafter referred to as comprehensive medical insurance, hospitalization medical insurance and supplementary medical insurance respectively), and pay employee medical insurance premiums according to the following provisions:

(a) employees of organs, institutions and social organizations must participate in comprehensive medical insurance; Other employers or individuals can choose to participate in comprehensive medical insurance or hospitalization medical insurance according to the actual situation. The payment standard of comprehensive medical insurance is: the unit pays 5.6% of the average monthly salary of employees, and the employees pay 2% of the average monthly salary (hereinafter referred to as the payment base and rate of comprehensive medical insurance, in which the employee payment base is referred to as the employee payment base). If the total average monthly salary of employees is lower than 60% of the average monthly salary of employees in full-caliber urban units weighted by the average monthly salary of employees in urban non-private units and employees in urban private units in this Municipality last year (hereinafter referred to as the average monthly salary of employees in this Municipality last year), it will be shared according to 60% of the average monthly salary of employees in this Municipality last year (hereinafter referred to as the lower limit of the comprehensive medical insurance payment base). If the total average monthly salary of employees is higher than 300% of the average monthly salary of employees in this Municipality last year, the medical insurance premium for employees will not be paid for the higher part (hereinafter referred to as the lower limit

The payment standard of hospitalization medical insurance is: the unit pays monthly according to 65438+ 0.6% of the average monthly salary of employees in the city last year (hereinafter referred to as the payment base and rate of hospitalization medical insurance), and employees do not pay. The insurance payment for flexible employees is the responsibility of the individual. Demobilized military cadres who choose their own jobs do not participate in comprehensive medical insurance during the employment period of the party and state organs, people's organizations, enterprises and institutions, and their retirement pensions are the payment base of comprehensive medical insurance, and medical insurance premiums are paid according to the prescribed proportion.

(2) Those who participate in employee medical insurance must participate in supplementary medical insurance, and the supplementary medical insurance premium shall be paid by the employing unit according to the average monthly salary of the whole city of 0. 1% (hereinafter referred to as the payment base and rate of supplementary medical insurance). The insurance payment for flexible employees is the responsibility of the individual. Enterprises to participate in the basic medical insurance in this city, can be established in accordance with the provisions of enterprise supplementary medical insurance, medical expenses subsidies for the insured units. The part of enterprise supplementary medical insurance premiums within 4% of the total wages of employees can be charged from the cost.