How much can employee medical insurance be reimbursed?

The sales proportion of employee medical insurance is as follows:

1, level 1 hospital, 90% for the part above the minimum threshold;

2, secondary hospitals, Qifubiaozhun to 10000 yuan (inclusive) to pay 85%, more than 10000 yuan to pay 90%;

3, tertiary hospitals, Qifubiaozhun to 5000 yuan (inclusive) of the part by 80%, 5000 yuan to 1 ten thousand yuan of the part by 85%, 1 ten thousand yuan of the highest payment limit by 90%;

4. Retirees will increase by 5% on the basis of the above payment ratio.

Specific reimbursement scope of employee medical insurance:

1, the expenses incurred during the period when the new insured fails to issue the social security card;

2 social security card loss, social security card replacement (replacement) card during the cost of medical treatment;

3, in the designated medical institutions without card emergency medical expenses;

4. Medical expenses during the default period;

5. Expenses incurred during the period of manual reimbursement for medical treatment;

6, in line with the conditions of the city's medical insurance fund payment in the field of medical expenses;

7. The annual expenses shall be declared before June 20th of the following year.

Medical insurance reimbursement materials:

1, the original ID card or social security card of this article;

2. Original disease diagnosis certificate issued by tertiary or secondary hospitals of designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If acting as an agent, provide the original ID card of the agent.

To sum up, according to the level of hospitalization expenses, the proportion of medical insurance reimbursement for employees is 85% between 1300 yuan and 30,000 yuan, 90% between 30,000 yuan and 40,000 yuan, 95% between 40,000 yuan and10000 yuan, and 85% between10000 yuan and 300,000 yuan.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

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.