Proportion of medical expenses reimbursed by employee social security

The proportion of employee social security reimbursement for medical expenses is as follows:

1, outpatient reimbursement ratio, after the basic medical insurance for urban employees, if they are on-the-job employees, they can only be reimbursed for medical expenses of more than 2,000 yuan, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan;

2. The proportion of hospitalization reimbursement. At present, when the basic medical insurance is first used within one year, the minimum payment for employees and retirees is 1300 yuan. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum payment limit (hospitalization expenses) of the basic medical insurance pooling fund within one year is currently 70,000 yuan;

3. Qifubiaozhun for hospitalization, level III includes hospitals above level III: The Qifubiaozhun for multiple hospitalizations within one year in 700 yuan is 500 yuan, 400 yuan and 300 yuan in turn, and the reimbursement rate of medical insurance for employees is 20 16. Secondary hospitals include secondary specialized hospitals: 600 yuan was hospitalized several times in one year, followed by 400 yuan, 300 yuan and 200 yuan. The first level includes the following hospitals: hospitalization in 500 yuan for many times within one year, and minimum compensation for 300 yuan and 200 yuan, 100 yuan. Above the deductible and below the maximum payment limit, 85% of class A and general medical expenses are paid by employees and 90% by retirees. Class B drugs pay 75% and cutting-edge drugs pay 70%. Medical insurance for employees with chronic diseases, special diseases and major diseases, the annual Qifubiaozhun is 700 yuan. Class A and general diagnosis and treatment 80%, class B 75%, high accuracy 70%.

The activation process of social security card is as follows:

1. Bank outlets are activated. Bring your ID card and social security card to the local social security card bank to activate the social security card, and the social security card can be officially used;

2. After the medical insurance designated hospital is activated, the outpatient or inpatient registration business can be handled when seeking medical treatment, and the social security card can be directly activated and put into use;

3. Medical insurance designated pharmacies are activated. Buy medicine at the designated pharmacy, insert the original medical insurance card, and then insert the social security card as required to activate the social security card. The activation period of the social security card is within the prescribed period from the date of receipt of the card. If it exceeds the card, it will be regarded as loss reporting and cannot be used. Therefore, consumers should use the above three methods to activate as soon as possible after getting the social security card.

The reimbursement process of social security card is:

1. When the insured person goes to see a doctor, he/she will write a prescription and pay the fee after taking the social security card.

2. The insured person goes to the outpatient clinic with the registration form, and the doctor registers the insurance card at the registration office;

3. After the insured person takes the prescription to the hospital settlement window for pricing, he can directly brush the social security card to pay the medical expenses within the scope of medical insurance fund payment;

4. If some drugs in the prescription are not covered by the medical insurance fund, the insured needs to pay cash.

Benefits of social security card:

1, to provide living security for the elderly when they are weak and unable to work. After paying the old-age insurance, you don't have to pay it again when you reach a certain age, and you can start receiving a monthly pension. Paying for basic necessities with pension can enjoy a more comfortable old age;

2. Provide daily life and living security. Medical insurance, maternity insurance and industrial injury insurance will all play a great role in the event of accidents, which can be said to be life support. Unemployment insurance, housing accumulation fund, to provide living security for the unemployed, to provide help for living and living;

3. In some big cities, social security is related to the qualifications of buying a house, settling down and buying a car. If you don't pay social security, you won't be qualified to buy a house, you won't be able to get an account, and you won't be able to participate in buying a car.

4. Social security for employees. Deducting social security when paying wages will reduce the payment of personal income tax. The national individual income tax policy stipulates that employee social security can be withheld and remitted before tax payment. After withholding and remitting the part that social security individuals should pay, the personal tax base will be reduced, and the personal income tax to be paid will also be reduced.

To sum up, the insured needs to bring his social security card and the original identity certificate to the corresponding bank outlets to activate the social security card, and the medical insurance account will return to normal after activation. Use social security card to directly enable social security function in designated medical insurance hospitals. When the insured person uses the social security card for the first time in a designated medical institution, he can directly activate the social security function by simply registering for outpatient service or hospitalization. When the insured uses the social security card for the first time in the designated medical insurance pharmacy, he inserts the original medical insurance card, and then inserts the social security card as required to activate the social security card.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.