Reimbursement amount of medical insurance for employees in Fuzhou

Basic medical insurance for urban workers:

(1) Personal account transfer method:

Based on my salary income and retirement expenses in the previous year, the personal account funds are distributed according to the following three age groups in different proportions: under 45 years old (including 45 years old), 2.3% (including individual contributions); Persons over the age of 45 who have not reached the statutory retirement age are included in 2.5% (including individual contributions); Retirees who reach the statutory retirement age are counted as 3.4%.

(2) Overall fund payment method:

The hospitalization deductible standard: tertiary hospital 700 yuan, secondary hospital 600 yuan, and hospital below the first level 500 yuan. If the insured person is hospitalized for many times in one insured year, the third-level hospital will be hospitalized in 500 yuan for the second time, 400 yuan for the third time, and then 300 yuan; The second hospitalization deductible line of the secondary hospital is 400 yuan, the third time in 300 yuan, and then in 200 yuan; First-class hospital hospitalization deductible line was in 300 yuan for the second time, in 200 yuan for the third time, and then it was 100 yuan.

Legal basis:

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

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall 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.

Derivative problem:

What is the medical insurance reimbursement rate of Mente?

The reimbursement standard for outpatient special diseases: (total outpatient expenses-total expenses-Qifubiaozhun-individual pays first) multiplied by the compensation ratio. Reimbursement ratio: urban workers can be reimbursed 85%, with an increase of 2% for those over 50, 4% or 89% for those over 60, 6% for those over 70 and 8% for those over 80 (inclusive), and the reimbursement ratio is within 100%.