How much is the starting amount of employee health insurance reimbursement

The starting reimbursement amount for employee health insurance is based on the health insurance policies of different regions, and the exact amount may vary. Generally speaking, the employee health insurance will start to reimburse after a certain amount of medical expenses, which is usually called the starting line.

A. The starting line

The starting line is an important element of the health insurance system, designed to control medical costs and avoid excessive medical consumption. Different regions will set different threshold amounts according to the level of local economic development and medical resources. This amount is usually the threshold at which reimbursement begins only after medical expenses have accumulated to a certain level.

The factors that determine the starting line

The determination of the starting line is affected by a variety of factors, including, but not limited to, the following:

1. The level of economic development and the distribution of healthcare resources in the region;

2. The income and expenditure of the healthcare insurance fund;

3. The adjustment and optimization of the healthcare insurance policy;

4, Reasonableness and necessity of medical expenses, etc.

Therefore, the amount of the starting line for employee health insurance may vary in different regions, and may even be adjusted in the same region over time.

Three, understand the local health insurance policy

In order to accurately understand the amount of the starting line of the employee health insurance, employees need to pay attention to the relevant provisions of the local health insurance policy. You can get the relevant information through the following ways:

1, consult the personnel department or financial department of your unit;

2, go to the consultation window of the local social security bureau or medical insurance center;

3, log on to the official website of the local social security bureau or medical insurance center to make inquiries.

Four, rational use of health insurance resources

Based on the understanding of the amount of the starting line, employees should rationally use health insurance resources to avoid unnecessary medical expenses. At the same time, they should also pay attention to their own health status, actively prevent diseases and reduce medical needs.

In summary:

The starting reimbursement amount of employee health insurance, i.e., the starting payment line, is based on the health insurance policies of different regions, and the exact amount may vary. Employees need to pay attention to the relevant provisions of the local health insurance policy, understand the amount of the starting line, and reasonably utilize the health insurance resources in order to reduce the burden of medical expenses.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 28 stipulates that:

Medical expenses that are in line with the basic medical insurance drug directory, diagnostic and therapeutic items, medical service facility standards, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

The Social Insurance Law of the People's Republic of China

Article 30 stipulates:

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the workers' compensation insurance fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health burden;

(iv) medical treatment outside the country.

Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.