How much is the medical insurance cap for urban workers in Beijing?

The Beijing Municipal Bureau of Human Resources and Social Security issued the "Notice on Doing a Good Job in Serious Illness Insurance for Urban Residents", and the out-of-pocket expenses exceeded 50,000 yuan and 60% were not capped.

The "Notice" clarifies the proportion of reimbursement for major illness insurance. Considering that most urban residents are special groups such as the elderly, children and the disabled, the reimbursement of serious illness insurance is designed according to the principle of "no ceiling" and "calculation by sections and cumulative payment" is implemented.

Among them, outpatient and hospitalization expenses are included in the reimbursement scope of serious illness medical insurance, and medical expenses above the deductible line and within 50,000 yuan are reimbursed by the serious illness insurance fund by 50%; Individuals pay more than 50,000 yuan for medical expenses, and the serious illness insurance fund will reimburse 60%, and there is no capping line.

Reimbursement expenses will be credited to the insured's passbook in April every year. In order to facilitate the insured, the Notice clarifies that when a seriously ill medical insurance patient reimburses the medical expenses again, he/she does not need to declare it himself, and the municipal medical insurance and social security agency will automatically review and handle it through the medical insurance information system. Those who meet the reimbursement conditions of serious illness insurance only need to wait for the notice of the agency.

According to reports, in the future, the medical insurance agencies in all districts and counties will start to review, compare information and deduct medical assistance from the serious illness insurance expenses of the previous year on February 15 every year, and will transmit the payment notice of those who enjoy serious illness insurance benefits to the social security agencies in all districts and counties before March 15. In April, the district and county social security agencies paid the reimbursement expenses of serious illness insurance for the insured. The reimbursement fee for serious illness will be credited to the insured's bank passbook for payment and deduction.

For some insured persons who have no payment passbook, the social security agency will send the reimbursement fee to the social security office where the insured person's household registration is located, and the social security office will inform the insured person to collect it in time. You should bring your resident identity card or residence booklet and social security card when you receive it.

Six out-of-pocket medical expenses

1. Medical expenses below the minimum deductible of the basic medical insurance fund for urban residents.

2. The medical expenses above the Qifubiaozhun and below the maximum payment limit of the urban residents' basic medical insurance pooling fund shall be determined in proportion and shall be borne by individuals.

3. The use of large medical equipment in examination and treatment projects and the medical expenses that should be borne by individuals first are above 200 yuan (inclusive).

4 basic medical insurance diagnosis and treatment project directory, medical service facilities within the scope of class B medical expenses should be borne by individuals in advance.

5 "Beijing basic medical insurance, industrial injury insurance and maternity insurance drug list" in the class B drugs should be borne by the individual medical expenses.

6 above the maximum payment limit of the basic medical insurance fund for urban residents, the medical expenses that can be included in the scope of reimbursement according to the provisions of the basic medical insurance fund for urban residents and the medical expenses that meet the above 3, 4 and 5 in the table.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.