Xiamen employee medical insurance payment standard 2023

The payment standards of medical insurance for employees in Xiamen in 2023 are as follows:

1. In a settlement year, medical expenses less than 654.38+10,000 yuan that meet the reimbursement scope occur:

(1) The threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan;

(2) The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%;

(3) There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;

2. The reimbursement rate of social security card hospitalization is: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total hospitalization reimbursement of 300,000 yuan. Inpatient deductible line: the standard of the first hospitalization deductible line in a natural year is 1.300 yuan, and 650 yuan every time thereafter;

3. Continuous payment is linked to the reimbursement ratio. After two years of continuous insurance, the reimbursement rate increased to 765,438+0%, and after four years of continuous insurance, the reimbursement rate increased to 72%, and so on. It should be reminded that in different cities, the reimbursement ratio of social security cards is different, which is mainly related to the local medical insurance benefits.

Employee medical insurance payment inquiry system;

1. Open Alipay and click more;

2. Click on the city service;

3. After entering, click on the electronic social security card;

4. Click the social security query;

5. After entering the social security interface, click the details of insurance payment;

6. Enter the insurance payment details interface and find basic medical insurance and large medical insurance, that is, medical insurance. Generally, basic medical insurance pays more.

7. Click on the basic medical insurance, you can see the medical insurance payment records, or you can see the large medical insurance payment records, which are generally underpaid.

To sum up, in 2023, the financing standard of basic medical insurance for urban and rural residents in Xiamen will be adjusted from 1 140 yuan to 1200 yuan per person per year, in which the financial subsidy standard will be adjusted from 740 yuan to 770 yuan per person per year, and the individual payment standard of basic medical insurance premium will be adjusted from 400 yuan to 430 yuan per person per year.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.