Provisions on the scope and amount of medical insurance reimbursement for employees

What is the scope and amount of medical insurance reimbursement for employees?

The scope of medical insurance reimbursement for employees mainly includes hospitalization expenses, outpatient serious illness expenses and drug purchase expenses at designated pharmacies. Among them, hospitalization expenses include medicine expenses, treatment expenses, operation expenses, nursing expenses, examination expenses, bed expenses, etc. The outpatient expenses for serious diseases mainly include special diseases and chronic diseases. The drug purchase expenses of designated pharmacies include drug expenses and medical equipment expenses.

Generally speaking, the reimbursement ratio and limit of employee medical insurance will vary according to different types and regions of medical expenses. For example, the reimbursement rate of hospitalization expenses is usually between 80% and 95%, the reimbursement rate of outpatient serious illness expenses is usually between 50% and 90%, and the reimbursement rate of drug purchase expenses in designated pharmacies is usually between 50% and 90%. In addition, employee medical insurance also has a maximum reimbursement limit, which generally ranges from tens of thousands to hundreds of thousands of yuan.

To sum up, the scope of employee medical insurance reimbursement mainly includes hospitalization expenses, outpatient serious illness expenses, and drug purchase expenses at designated pharmacies. And the reimbursement amount varies according to different types of medical expenses and regions. You can consult the local social security bureau or medical insurance agency for details.

Legal basis:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "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 30 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party. "