Proportion of hospitalization reimbursement of medical insurance for employees in Zhengzhou city

For employees who work in the company, employees who work in the company generally need to buy a medical insurance for their employees. For employee medical insurance, if reimbursement is required, it needs to be reimbursed according to the reimbursement ratio.

1. What's the reimbursement rate of employee medical insurance?

(A) the proportion of outpatient reimbursement

After getting the basic medical insurance for urban workers, if they are on-the-job workers, they can only be reimbursed for medical expenses of more than 2,000 yuan in the outpatient and emergency departments of hospitals, and the reimbursement rate 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.

For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

(2) 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 annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

(3) Qifubiaozhun for hospitalization

Three-level hospitals and above: The deductible lines for multiple hospitalizations in 700 yuan within one year are 500 yuan, 400 yuan and 300 yuan, 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 on-the-job employees.

Retiree payment: 90%. 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%.

Second, how much medical insurance do employees have to pay each year?

Generally speaking, in terms of employee medical insurance payment, men pay for 25 years and women pay for 20 years. In this case, you can also enjoy medical reimbursement after retirement. As for the payment standard, in fact, the annual payment amount is uncertain, depending on your salary base and payment grade. So, there is no definite quantity.

Employees' social security shall set up personal accounts, which are mainly used for seeking medical treatment in outpatient clinics of designated medical institutions and purchasing medicines in designated retail pharmacies. There is no personal account for residents' medical insurance, and outpatient medical treatment is coordinated. As the medical insurance certificate of the insured, there is no money in the medical insurance card, but the detailed information of the insured and the reimbursement of payment are recorded. It is recommended to consult the local social security bureau.

As for the amount returned, it is actually not fixed. Every employee's medical insurance payment standard is different, so the money returned is different. Also, generally speaking, only employees' medical insurance can refund their money, and individuals who pay medical insurance cannot refund their money. Because individuals pay social security at their own expense, there is no part paid by enterprises, so there is no refund before retirement, and only after retirement can the money be refunded to the card.

Legal objectivity:

The proportion of medical insurance reimbursement for urban workers is 1, and 90% of the part above the threshold to the maximum payment limit is paid in a first-class hospital; 2, secondary hospitals, Qifubiaozhun to 10000 yuan (inclusive) to pay 85%, more than 10000 yuan to pay 90%; 3. 80% of the minimum deductible of tertiary hospitals is above 5,000 yuan (inclusive), 85% of the minimum deductible of 5,000 yuan to 10000 yuan, and 90% of the maximum deductible of 10000 yuan. 4. Retirees will increase by 5% on the basis of the above payment ratio. The reimbursement scope of employee medical insurance hospitalization is 1, and the expenses incurred during the period when the new insured does not issue a 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. According to the provisions of Article 28 of the Social Insurance Law of People's Republic of China (PRC), the list of drugs, diagnosis and treatment items, scope of medical service facilities and emergency and rescue standards that meet the basic medical insurance shall be paid by the basic medical insurance fund in accordance with state regulations.