Beijing medical insurance deductible reimbursement

The qifubiaozhun for hospitalization reimbursement of medical insurance in Beijing is set at about 10% of the average salary of employees in this city last year.

According to Article 32 of the Regulations of Beijing Municipality on Basic Medical Insurance, the Qifubiaozhun paid by the basic medical insurance pooling fund is determined at about 10% of the average salary of employees in this city in the previous year. The medical expenses incurred by an individual in hospitalization for the second time or later in a year, the Qifubiaozhun is determined according to about 5% of the average salary of employees in this city in the previous year.

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Extended data:

Article 36 of the Regulations of Beijing Municipality on Basic Medical Insurance, the medical expenses incurred by employees and retirees in a settlement period shall be calculated by sections and paid cumulatively according to the level of the hospital and the amount of expenses, and shall be shared by the basic medical insurance pooling fund and individuals according to the following proportions:

(1) Medical expenses incurred in tertiary hospitals:

1, with the minimum threshold of 30,000 yuan, 85% paid by the overall fund and15% paid by the employees;

2, more than 30 thousand yuan to 40 thousand yuan, 90% of the overall fund to pay, individual employees pay10%;

3, more than 40 thousand yuan, the overall fund to pay 95%, workers pay 5%.

(two) medical expenses incurred in secondary hospitals:

1, with the minimum payment of 30,000 yuan, 87% paid by the overall fund and13% paid by employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(3) Medical expenses incurred by first-class hospitals and family beds:

1. 90% of the minimum threshold is 30,000 yuan, and 90% is paid by the overall fund and10% by the employees;

2, more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;

3, more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(4) The individual contribution ratio of retirees is 60% of the employees.

However, the maximum amount of proportional payment of the basic medical insurance pooling fund shall not exceed the maximum payment limit stipulated in Article 33 of these Provisions. When the payment ratio of the basic medical insurance fund listed in the first paragraph of this article needs to be adjusted, the municipal labor and social security administrative department shall, jointly with the municipal finance department, put forward an adjustment plan, which shall be promulgated and implemented after being approved by the Municipal People's government.

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