Proportion of medical insurance reimbursement for employees in Xiamen

The reimbursement ratio of social security and medical insurance is as follows:

First, the proportion of hospitalization reimbursement:

1, a first-class hospital, 90% can be reimbursed for the part exceeding Qifubiaozhun to the highest payment limit;

2, secondary hospitals, Qifubiaozhun above to 1 ten thousand yuan can compensate 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%;

3, tertiary hospitals, more than Qifubiaozhun to 5000 yuan can be compensated by 80%; 5000 yuan to 1000 yuan, can be compensated for 85%; The part exceeding the maximum payment limit of 6,543,800 yuan can be compensated by 90%.

4 retirees can increase 5% on the basis of the above reimbursement ratio.

Two, hospitalization reimbursement deductible:

1, a first-class hospital in 200 yuan;

2, the secondary hospital Wu Bai yuan;

3. 800 yuan, a tertiary hospital;

4, malignant tumor patients, in a medical year for many times due to radiotherapy and chemotherapy medical expenses, only calculate a deductible.

III. Proportion of reimbursement for outpatient chronic diseases: Outpatient chronic diseases are divided into Class A chronic diseases and Class B chronic diseases.

1. The outpatient medical expenses that meet the requirements due to illness of patients with chronic diseases of Class A shall be compensated by the overall fund by 85%. Outpatient hemodialysis expenses, peritoneal dialysis expenses and cyclosporine A expenses for patients with chronic renal failure (renal failure) after organ transplantation shall be reimbursed on the above basis, and then increased by 10%.

2. B Chronic disease deductible standard: 300 yuan. The outpatient medical expenses incurred by patients with chronic diseases of Class B due to illness can be reimbursed by 80% for the part exceeding the deductible standard, and shall not be higher than the maximum payment limit for chronic diseases within a medical year (or within the validity period).

3. The insured can identify two chronic diseases of Class B at the same time, and calculate the deductible of each disease according to the management of the first two diseases. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

Legal basis: According to the provisions of the Social Insurance Law, the following medical expenses are not included in the payment scope of the medical insurance fund for urban and rural residents:

1, which shall be paid from the industrial injury insurance fund;

2, should be borne by a third person;

3, should be borne by public health;

4. Go abroad for medical treatment.

Legal basis:

"People's Republic of China (PRC) basic medical and health promotion law" eighty-second expenses are mainly paid by the basic medical insurance fund and individuals. The state raises basic medical insurance funds through various channels according to law, and gradually improves the mechanism of sustainable financing and adjusting the level of basic medical insurance protection.

Citizens have the right and obligation to participate in basic medical insurance according to law. Employers and employees pay basic medical insurance premiums for employees in accordance with state regulations. Urban and rural residents pay the basic medical insurance premiums for urban and rural residents according to regulations.

Article 83 The state establishes a multi-level medical security system with basic medical insurance as the main body, supplemented by commercial health insurance, medical assistance, mutual medical care for employees and medical charity services.

The state encourages the development of commercial health insurance to meet the diverse health protection needs of the people.

The state improves the medical assistance system to ensure that eligible people in need get basic medical services.