Jilin province employee health insurance reimbursement ratio 2024

2024 Jilin Province employee health insurance reimbursement ratio:

1, Class B health insurance general drugs, diagnostic and treatment items and medical services and facilities items, medical consumables personal first out-of-pocket expenses ratio of the active staff adjusted to 10%, retirees adjusted to 8%.

2, for major diseases protection treatment, for the second level and above the provincial designated medical institutions for 39 major diseases, the implementation of payment by disease.

The process of reimbursement for hospitalization under Jilin Employees' Medical Insurance:

1. When you are admitted or discharged from the hospital, you must go to the medical insurance management window of each designated medical institution with your medical insurance IC card to go through the registration procedures for hospitalization. When you are hospitalized, you have to pay the deposit in advance, and you will be reimbursed after you are discharged from the hospital. Medical fees incurred before hospitalization registration are not covered by basic medical insurance. If you are hospitalized due to an emergency and cannot complete the hospitalization registration procedures in time, you should go to the medical insurance management window on the next day after you are admitted to the hospital with the certificate of the emergency to complete the hospitalization procedures (postponed in case of holidays), and you will be responsible for the medical fees incurred in excess of the time limit.

2. The starting line of the integrated fund after hospitalization: the starting line varies from place to place and is generally 10% of the average annual salary of the city's employees in the previous year, and the medical fees for multiple hospitalizations are calculated cumulatively in a basic medical insurance settlement year.

3, the insured person's condition requires referral or transfer to a hospital, must be diagnosed by the deputy chief physician or section chief of the designated medical institution above the third level and put forward the opinion of the referral (hospital), the unit to fill in the application form, by the designated medical insurance management department of medical insurance agreed to report to the city (district) social security institutions for approval after the referral (hospital) procedures.

In summary, Jilin Province has adjusted the reimbursement rate of employee health insurance in 2024 and adopted a series of policy reforms aimed at improving the level of medical protection, reducing the medical burden of insured persons, and ensuring the sustainability of the health insurance fund and the rational use of medical resources.

Legal basis:

The People's Republic of China*** and the State Social Insurance Law

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and salvage, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured 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.