What is the top line of Beijing medical insurance?

The ceiling for hospitalization in Beijing is 500,000.

The reimbursement rate of employees in Beijing is over 85%, that of retirees is over 90%, with a maximum of 99. 1%, and the maximum hospitalization limit is 500,000 yuan.

From 20211/urban and rural residents' basic medical insurance, the maximum payment limit of the fund for outpatient and emergency medical expenses incurred in a medical insurance year is increased from 4,000 yuan to 4,500 yuan.

1, medical insurance is divided into two accounts, personal account, and the money reflected in the medical insurance card can be used to buy medicines at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that the individual pays; The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.

2. When seeking medical treatment (hospitalization), show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, so the individual does not need to pay first and then reimburse. Medical expenses of outpatients cannot be reimbursed.

Social medical insurance reimbursement:

1, different hospitals have different reimbursement rates for medical insurance. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. (Note that medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not medical insurance and cannot be reimbursed.)

2. The proportion of on-the-job employees' hospitalization medical expenses reimbursement. Except for the self-funded part and 10%, the part of Class B expenses that exceeds the deductible expenses of hospital medical insurance enjoys the proportion of overall payment. Different hospitals have different deductible expenses, and the proportion of overall payment is also different. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan).

3. The social security card has not adjusted any proportion of medical reimbursement. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. Payment institutions need to prepare copies of medical insurance manuals, medical bills, receipts and details when handling reimbursement procedures. For details, please also consult the labor security telephone number 12333.

legal ground

People's Republic of China (PRC) social insurance law

Article 28

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 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business 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.