Employee health insurance hospitalization reimbursement rate 2024 standard

The hospitalization reimbursement rate of employee health insurance:

1. The reimbursement rate is 85% if the employee's hospitalization costs between 1,300 yuan and 30,000 yuan.

2. The reimbursement rate for an employee's hospitalization costing between $30,000 and $40,000 is 90%.

3. The reimbursement rate is 95 percent for employees spending between $40,000 and $100,000 on hospitalization.

4. The reimbursement rate is 85% if the employee's hospitalization costs between 100,000 yuan and 300,000 yuan.

Employee health insurance hospitalization reimbursement process:

1. Preparation before medical treatment. Participants should carry their medical insurance cards and show them to the designated hospitals to prove their participation status before seeking medical treatment.

2. Hospitalization registration. When going through the hospitalization procedure, the insured person should inform the hospital that he/she is a patient of the medical insurance and register for the medical insurance within 48 hours after the admission.

3. Management during hospitalization. During hospitalization, you need to carry your ID card or social security card with you, and you can't leave the hospital at will in case of audit by the staff of the Health Insurance Office.

4. Settlement during hospitalization. When discharged from the hospital, the insured person should bring his ID card or social security card, agent's ID card, and deposit slip to the hospitalization office for the discharge settlement procedures and settle the personal out-of-pocket payment.

5. Reimbursement application. After being discharged from the hospital, the insured person needs to bring the relevant reimbursement materials, such as hospitalization invoice, detailed list of expenses, medical records, etc., and submit the reimbursement application to the local social security department or through the electronic channel.

6. Reimbursement review and settlement. After the reimbursement materials are submitted, the relevant department will audit the reimbursement, and the reimbursement amount will be transferred to the bank account of the insured person after the audit is approved.

In summary, the specific process and rate of hospitalization reimbursement for employee health insurance in 2024 may vary from region to region, and it is recommended that participants consult their local social security departments for accurate information in advance.

Legal basis:

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

Article 23

The specific measures for basic medical insurance for employees shall be prescribed by the State Council.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.