Henan employee medical insurance hospitalization reimbursement ratio is how much

We all know that medical insurance is an important part of the social insurance system, and the state has formulated relevant regulations to clearly stipulate the obligation of employers to pay medical insurance for employees. Among them, the cost of individual employee medical insurance is paid by the unit and the individual employee **** the same.

I. The reimbursement ratio of individual employee medical insurance

1. In a first-class hospital, for the part of the starting standard of 30,000 yuan, the basic medical insurance can be paid 90% by the integrated fund, and the individual employee needs to pay 10%. If the starting standard is more than 30,000-40,000 yuan, its coordinated fund pays up to 95%, and the individual employee only needs to bear about 5%. If the starting standard exceeds 40,000 yuan or more, the co-ordination fund of the basic medical insurance pays a lofty 97%, and the individual employee pays 3%.

2, in the second level hospital, the starting standard for 30,000 yuan part, basic medical insurance can be paid by the integrated fund of 87%, the individual employee to pay up to 13%; if more than 30,000 yuan - 40,000 yuan part of the medical costs, can be paid by the integrated fund of 92%, the individual employee needs to pay 8%; if the medical costs of more than 40,000 yuan of part. If the medical expenses exceed 40,000 yuan, the basic medical insurance can be paid by the integrated fund can be as high as 97%, individual employees only need to pay 3%.

3. In the third-level hospitals, the basic medical insurance can cover 85% of the medical expenses up to 30,000 yuan by the integrated fund, and the individual employee only needs to pay 15%; if the medical expenses exceeding 30,000 yuan to 40,000 yuan, the basic medical insurance can cover 90% of the medical expenses by the integrated fund, and the individual employee only needs to pay 10%; if the medical expenses exceeding 40,000 yuan, the integrated fund can cover 90% of the medical expenses by the integrated fund, and the individual employee only needs to pay 10%. If the medical expenses exceed 40,000 yuan, the coordinated fund can pay 95% and the individual employee only needs to pay 5%.

4. Among them, the individual payment ratio of the retirees only accounts for 60% of the share of the employee's payment ratio.

The prerequisites for the reimbursement of individual employee medical insurance

1, the applicant has already applied for the insurance procedures and paid the full amount of medical insurance premiums.

2. The insured person has incurred hospitalization medical expenses in the filed medical institution and paid cash in advance and kept the relevant documents and information.

3, to the cooperative medical designated medical institutions: participants in the individual choice of health insurance designated hospitals or specialized hospitals, Chinese medicine hospitals and hospitals of the A class of the general outpatient, emergency medical expenses incurred.

4. Prepare original invoices: general outpatient, emergency expenses paid in cash by the individual, resulting in medical expenses to be within the scope of the three major directory banks of medical insurance.

5, bring the medical insurance card and my ID card: 1-20 days a month, the month's expenses will be declared in the following month, the current year's expenses will be applied for reimbursement before January 20 of the following year.

6. Participants submit the documents to the unit or social security office, which enters them into the enterprise version and then declares the electronic information and documents to the health insurance center.

Employees need to be reimbursed by medical insurance once they fall ill. The general reimbursement rate of medical insurance varies according to the level of medical treatment and the amount of medical expenses incurred. The above is the employee's personal health insurance reimbursement rate of the relevant content, I hope to help you. If you still do not understand anything, you can consult the relevant lawyers online.

The hospitalization reimbursement ratio of urban workers' medical insurance 1, first-class hospitals, above the starting standard to the maximum payment limit of the part of the payment of 90%; 2, second-class hospitals, above the starting standard to the part of 10,000 yuan (including) payment of 85%, more than 10,000 yuan to the maximum payment limit of the part of the payment of 90%; 3, tertiary hospitals, starting standard to 5,000 yuan (including) payment of 90%; 3, third-class hospitals, the starting standard to 5,000 yuan (including) payment of 90%. For tertiary hospitals, 80% of the portion of the starting payment standard up to and including 5,000 yuan, 85% of the portion of the standard from 5,000 yuan to 10,000 yuan, and 90% of the portion of the standard above 10,000 yuan up to the maximum payment limit.4 For retired staff, a 5% increase is added to the above payment rates. The scope of reimbursement for hospitalization under the Employees' Health Insurance is as follows: 1) Expenses incurred during the period when the newly enrolled social security card is not issued; 2) Expenses incurred during the period when the social security card is lost and replaced; 3) Expenses incurred during the period when the card is not held for emergency treatment in designated medical institutions; 4) Expenses incurred during the period of arrears of payment; 5) Expenses incurred during the period of manual reimbursement; 6) Expenses incurred during the period when the medical treatment is provided in a foreign country that meets the conditions for payment by the city's medical insurance fund; 7) Expenses incurred during the current year's medical treatment. Expenses incurred during the current year must be declared before January 20 of the following year. Legal basis "Chinese people *** and the State Social Insurance Law" Article 28: in line with the basic medical insurance drug list, diagnostic and treatment items, medical service facilities standards, as well as emergency, rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.