Scope and proportion of medical insurance reimbursement in Beijing

Scope and proportion of medical insurance reimbursement:

1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents. The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%.

Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4. Reimbursement of major illness insurance. After the insured suffers from a serious illness, the personal conceit part that meets the requirements of the municipal medical insurance in the designated medical institutions of the municipal medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% shall be reimbursed by the serious illness insurance fund.

According to your situation:

1, your situation is not covered by medical insurance reimbursement. Because the company didn't give you medical insurance before, of course, medical insurance won't reimburse you, but this is an obvious company violation, and the company has to bear the responsibility and punishment.

Beijing has a new medical insurance. After the medical insurance card is obtained, it will take effect the next month. Individuals can set up four designated hospitals, which can be adjusted once a year. There is no need to go to a tertiary hospital for treatment, and there is no reimbursement for going to a secondary hospital.

3. You don't need to pay in advance to take the medical insurance card to the hospital, you only need to pay the personal part.

4. Inpatient deductible: 1.3 million yuan, after which 85% will be reimbursed, and the annual quota is 1.7 million yuan. Outpatient deductible line: 1800 yuan, 70% will be reimbursed afterwards, and only 20,000 yuan will be paid each year.

5. No, you can only buy one kind of social security and rural medical insurance, and all medical reimbursement can only be reimbursed once by invoice.

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Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.

20 16 65438+ 10/2 the State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, demanding that the basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) and the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system) be integrated and a unified basic medical insurance system for urban and rural residents (hereinafter referred to as urban and rural residents' medical insurance) be established.

References:

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