Cumulative reimbursement amount of employee medical insurance for one year

The upper limit of reimbursement for employees' medical insurance hospitalization is 500,000 yuan, and the upper limit of reimbursement for employees' medical insurance insured outpatients is 20,000 yuan in a natural year.

The differences between the first and second social security files are as follows:

1, the payment is different. The base of the first payment is the total monthly salary of employees, and the payment ratio is 8.2%, of which the company pays 6.2% and the individual pays 2%. The second payment base is the average monthly salary of employees in Shenzhen last year, and the payment ratio is 0.8%, of which the company pays 0.6% and the individual pays 0.2%. The base of the third-grade payment is the average monthly salary of employees in Shenzhen last year, and the payment ratio is 0.55%, of which the company pays 0.45% and the individual pays 0.1%;

2. Personal accounts are different, only one file has a personal account, and the second and third files do not. After the balance of the social security account reaches the payment conditions, the first-level insured can go to the designated medical insurance pharmacy to buy medicine, or they can use their personal accounts to carry out health check-ups and vaccinations for themselves, their spouses and immediate family members. The second and third types of insured people can't go to the designated medical insurance pharmacy to buy medicine with the medical insurance card, and social security can't be shared with their families.

3, outpatient treatment is different, outpatient reimbursement is also divided into general outpatient service, serious illness outpatient service, outpatient blood transfusion, outpatient special inspection, etc. The first file can be paid or reimbursed by the medical insurance through the money in the personal account, and the second and third files can only be reimbursed for the general outpatient service of the community health service, and the maximum reimbursement can only be 1000 yuan per year. Different drugs also have different reimbursement rates.

Employee medical insurance processing flow:

1. After the employee joins the company, the company will submit the employee's personal information and medical insurance payment information to the local social insurance agency within the specified time to handle the medical insurance registration for the employee;

2. Employees hold valid identity documents and personal medical insurance cards to the local social insurance agencies to handle the activation and collection procedures of medical insurance cards, and at the same time understand the local medical insurance policies and reimbursement standards;

3, employees and units in accordance with the provisions of the medical insurance payment ratio to pay medical insurance fees;

4. When employees need medical treatment, they should go to the medical institutions designated by medical insurance for treatment, pay the expenses paid by individuals, and receive medical bills and other related materials;

5. Employees should prepare reimbursement application materials (such as medical bills, expense lists, diagnosis certificates, etc.). ) and apply for medical insurance reimbursement at the local social insurance agency;

6 agencies to review the application materials for reimbursement, verify the proportion and amount of reimbursement, and the reimbursement will be credited to the employee medical insurance card account.

To sum up, the balance in the medical insurance account can only be used to pay medical expenses within the scope of medical insurance and cannot be used for other purposes.

Legal basis:

Article 27 of People's Republic of China (PRC) Social Insurance Law

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.