Beijing Medical Insurance Outpatient Reimbursement Ratio 2022

In 2022, the reimbursement rate of outpatient service in Beijing employees' hospitals will reach over 70%, retirees will reach over 85%, and community health institutions will all reach 90%. Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation. The establishment and implementation of the basic medical insurance system has gathered the economic strength of units and social members. With the government's funding, sick social members can get the necessary material help from society, reduce the burden of medical expenses, and prevent sick social members from becoming poor due to illness. Medical insurance is one of the five insurances of social security. Medical expenses can be partially reimbursed by medical insurance, which can reduce our pressure. Medical insurance reimbursement is based on the local reimbursement ratio, and the reimbursement ratio is different in different regions. 1.

I basic medical insurance benefits for urban workers in Beijing:

1. In Beijing, more than 70% of employees are reimbursed for outpatient service in hospitals, more than 85% for retirees, 90% for community health institutions and 20,000 yuan for outpatient service.

2. In Beijing, the reimbursement rate of in-service employees is over 85%, and that of retirees is over 90%, reaching 99. 1%, and the maximum hospitalization limit is 500,000 yuan.

Two. Basic medical insurance benefits for urban and rural residents in Beijing:

From 1.202 1 year 1 month 1 year, the maximum payment limit of the fund is raised from 4,000 yuan to 4,500 yuan for the outpatient and emergency medical expenses incurred by the participants of the basic medical insurance for urban and rural residents in a medical insurance year.

Note: ① The hospitalization deductible in the above table refers to the first hospitalization in this year, and the elderly and working-age residents are hospitalized for the second time and later this year, and the deductible is halved.

② The deductible line for hospitalization of students and children is halved.

③ The reimbursement rate of inpatients in designated hospitals at district level is 78%.

Third, outpatient expenses.

1. Work

(1) deductible line for reimbursement of medical expenses of urban community health service institutions 1800, with the reimbursement ratio of 90% and the maximum reimbursement of 20,000 yuan a year;

② For non-community health service institutions, the deductible line for reimbursement of medical expenses is 1800, and the reimbursement rate is 70%, with a maximum reimbursement of 20,000 yuan a year.

retire

(1) Under 70 years of age (non-community health service institutions), the deductible line for medical expenses reimbursement is 1300, the reimbursement rate is 70%, and the supplementary medical insurance is 15%, with the maximum reimbursement of 20,000 yuan within one year;

(2) Under the age of 70 (see a doctor in a community health service institution in this city), the deductible line for medical expenses reimbursement is 1300, the reimbursement rate is 80%, and the supplementary medical insurance is 10%, and the maximum reimbursement within one year is 20,000 yuan;

③ The deductible line for reimbursement of medical expenses over 70 years old 1300, with the reimbursement ratio of 80% and supplementary medical insurance of 05%. The maximum reimbursement within one year is 20,000 yuan.

Fourth, hospitalization expenses.

1. Work

① The deductible line for reimbursement of medical expenses paid by the overall fund is less than 30,000 yuan, the reimbursement rate of tertiary hospitals is 85%, that of secondary hospitals is 87%, and that of primary hospitals is 90%, with a maximum reimbursement of 6,543,800 yuan a year;

② The deductible line of medical expenses paid by the overall fund is 30,000-40,000 yuan, the reimbursement rate of tertiary hospitals is 90%, that of secondary hospitals is 92%, and that of primary hospitals is 95%, with a maximum annual reimbursement of 654.38+10,000 yuan;

③ The deductible line of medical expenses paid by the overall fund is 40,000 yuan-the capping line, and the reimbursement rate of tertiary hospitals is 95%, secondary hospitals are 97%, and primary hospitals are 97%, with a maximum reimbursement of 654.38+10,000 yuan a year;

(4) The reimbursement rate of medical expenses paid by the large medical mutual fund for employees is 85%, with a maximum reimbursement of 200,000 yuan within one year.

retire

① The deductible of medical expenses paid by the overall fund is less than 30,000 yuan, and the reimbursement rate of tertiary hospitals is 9 1%, that of secondary hospitals is 92.2%, and that of primary hospitals is 94%, with a maximum reimbursement of 654,380+10,000 yuan a year;

② The deductible of medical expenses paid by the overall fund is 30,000-40,000 yuan, the reimbursement rate of tertiary hospitals is 94%, that of secondary hospitals is 95.2%, and that of primary hospitals is 97%, with a maximum reimbursement of 6,543,800 yuan a year;

③ The deductible line of medical expenses paid by the overall fund is 40,000 yuan-the capping line, and the reimbursement rate of tertiary hospitals is 97%, secondary hospitals are 98.2%, and primary hospitals are 98.2%, with a maximum reimbursement of 6,543,800 yuan a year;

(4) The reimbursement rate of medical expenses paid by retirees' large medical mutual fund is 90%80%+ 1%, and the maximum reimbursement is 200,000 yuan a year.

Remarks: If the single hospitalization expense exceeds 70,000 yuan, it must be reported to the municipal medical insurance for review.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 28 1 Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured are paid by the basic medical insurance fund and directly settled by social insurance agencies, medical institutions and drug trading units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits. 1

Beijing Medical Insurance Reimbursement Process:

1. When the insured person goes to the designated hospital for medical treatment, he must carry the Beijing Medical Insurance Manual with bar code;

2. Designated medical insurance hospitals should check the handbook of the insured, collect the basic information of the insured through the barcode on the handbook, issue the medical expense documents issued by the emergency department, and upload the outpatient expenses of the insured to the medical insurance information system in a timely and accurate manner.