What is the reimbursement rate of Beijing medical insurance?

The starting payment line is 300 yuan/times for first-class medical institutions, 600 yuan/times for second-class medical institutions and 1,200 yuan/times for third-class medical institutions. The reimbursement rate is 95% for one type of medical institution, 90% for two types of medical institutions, and 85% for three types of medical institutions, of which 90% is paid by the fund for the hospitalization of surgical treatment of malignant tumors, surgical treatment of cardio-cerebral diseases, and surgical treatment of liver, kidney and bone marrow transplantation.

With the development of China's society, medical insurance has become one of the common insurance in our daily life, in the medical treatment will be in accordance with the provisions of the insurance of some medical expenses, so as to reduce the burden of medical care, to protect our daily medical consumption level. The first thing you need to do is to get your hands on some of the most popular products and services in the world, and then you can get your hands on some of the most popular ones.

Medical insurance refers to the adoption of national legislation, in accordance with the principle of compulsory social insurance basic medical insurance premiums should be paid by the employer and the individual employee in full and on time. If you don't pay in full and on time, you can't count on your personal account, and the basic medical insurance fund will not pay for your medical expenses. In Beijing, for example, the proportion of medical insurance contributions: the employer monthly in accordance with the total contribution base of 10% of the payment, the employee in accordance with the 2% of his salary 120 dollars of the total payment of the major diseases.

Medical insurance is a kind of insurance to compensate for the medical expenses caused by diseases. Employees due to illness, injury, childbirth, by the community or enterprises to provide the necessary medical services or material help social insurance. Such as China's public medical care and labor insurance medical care. The medical expenses of Chinese employees are borne by the state, the organization and the individual*** together, in order to reduce the burden on enterprises and avoid wastage. Occurrence of insurance liability accidents need to be treated is the proportion of the insurance payment.

Beijing medical insurance reimbursement ratio

A, outpatient expenses

(a) reimbursement scope: the insured person in the individual choice of medical insurance designated hospitals or specialized hospitals, Chinese medicine hospitals and hospitals of category A (Youyi, Xuanwu, Guang'anmen Traditional Chinese Medicine, Tongren, Xiehe, Peking Third Hospital, Beidai People's Hospital, Peking University, Peking University First, Jishuitan, Chaoyang, Jian Gong, Liangxiang) incurred general outpatient and emergency expenses.

(2) Reimbursement ratio: for general outpatient and emergency expenses incurred in a natural year, if the total amount of outpatient and emergency expenses incurred by an employee exceeds 2,000 yuan, the part of the medical fund above 2,000 yuan will be paid 50%, and the individual will pay 50% out of his/her own pocket. For retirees, the total amount exceeds 1,300 RMB, and the portion of 1,300 RMB or more is 70% paid by the large medical mutual fund for those who have reached the age of 70, and 30% paid by the individual, and 80% paid by the large medical mutual fund for those who have reached the age of 70, and 20% paid by the individual. The maximum payment limit of 20,000 yuan in a natural year.

(C) medical management: general outpatient, emergency expenses personal cash payments, medical expenses incurred in line with the scope of the three major directories of health insurance library, purchasing drugs should be the first in the designated hospitals to issue a special prescription and stamped with the special seal of health insurance purchases, and then to the designated pharmacy to buy drugs.

(4) reimbursement process: a natural year cumulative more than the starting standard, the insured person will be submitted to the unit or social security office, the unit or social security office will be entered into the documents of the enterprise version of the electronic information and documents will be declared to the medical insurance center. The medical insurance center will complete the audit, settlement and payment within 15 working days.

II. Hospitalization Expenses

(1) Reimbursement: Hospitalization expenses incurred by insured persons at the designated hospitals or specialized hospitals of their choice for medical insurance, Chinese medicine hospitals, and hospitals of category A. The hospitalization expenses incurred by insured persons at the designated hospitals or specialized hospitals of their choice for medical insurance, Chinese medicine hospitals, and hospitals of category A.

(ii) Reimbursement rate: the starting standard for the first hospitalization in a natural year is 1300 RMB, and 650 RMB for each subsequent hospitalization. The payment rate is divided into three grades, with three hospitals, for example, the starting standard:30,000 yuan, 85% in service, 91% retired, 30,000-40,000 90% in service, 94% retired, more than 40,000, 95% in service, 97% retired. General hospitalization 90 days as a billing cycle. 360 days for psychiatric hospitalization is a billing cycle, and the starting and ending standards are halved. Maximum payment of 70,000 yuan from the integrated fund in one natural year. The maximum payment for hospitalized large amount is 100,000 yuan, and the payment ratio of hospitalized large amount is always 70%.

(C) Management of medical treatment: Please use the "Beijing Medical Insurance Handbook" when seeking medical treatment. If the unit pays in full, the individual only needs to pay part of the hospitalization advance payment, and then can go through the hospitalization procedures. The medical expenses incurred should be in line with the scope of the three major catalogs of the medical insurance library.

(d) Reimbursement process: the hospital and the individual to settle the amount of out-of-pocket expenses and deductibles when discharged, the amount of reimbursement of the integrated fund by the hospital and the district health insurance center.

Third, outpatient special disease

(a) the scope of reimbursement: malignant tumors radiotherapy, renal dialysis, kidney transplantation after taking anti-rejection drugs of the insured, in the special disease approval procedures, the occurrence of outpatient special disease medicine within the scope of outpatient medical expenses.

(ii) Reimbursement rate: The reimbursement rate is the same as hospitalization. The settlement cycle for outpatient special diseases is 360 days.

(3) Management of medical treatment: Participants can only choose one hospital as the designated hospital for special diseases, and please use the "Beijing Medical Insurance Manual" when seeking medical treatment. If the unit pays in full, the individual only needs to pay the individual out-of-pocket expenses and the amount of the deductible, the amount of reimbursement from the integrated fund by the hospital and the district health insurance center settlement.

(4) Reimbursement process: The insured person will submit the documents to the unit or social security office, and the unit will declare the documents to the medical insurance center. The medical insurance center to complete the audit, settlement, payment work on the same day

Above is the Beijing medical insurance reimbursement ratio, I hope it can help you. We should actively buy medical insurance in our daily life, now the medical insurance has urban medical insurance, social security, and commercial insurance, they can effectively reimburse part of the medical expenses incurred in the medical treatment, reduce our medical burden.