Proportion of bed fee reimbursement

Legal analysis: According to the provisions of the Social Insurance Law, medical expenses that meet the medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency rescue standards for employees shall be paid by the basic medical insurance fund in accordance with state regulations.

1, scope of medical insurance drug reimbursement for employees

(1) Class A drugs refer to drugs that are basically unified in China and can meet the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard.

(2) The list of Class B drugs shall be adjusted by the provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions. Before such drugs are included in the payment scope of the basic medical insurance fund, the employees shall pay according to a certain proportion and pay according to the basic medical insurance payment standard.

2, employee medical insurance service facilities reimbursement scope

The necessary living service facilities in the process of diagnosis, treatment and nursing mainly include hospital bed fee or outpatient (emergency) observation bed fee.

The basic medical insurance fund does not pay for living services and service facilities, mainly including:

(1) outpatient and first aid (transfer) transportation expenses;

(2) Air conditioning fee, TV fee, telephone fee, baby incubator fee and food incubator fee;

(3) Escort fee, nursing fee, washing fee and outpatient decocting fee;

(4) meals;

(5) Hospitality and other special life service expenses.

3, employee medical insurance reimbursement ratio

The proportion of medical insurance reimbursement for employees varies from place to place, taking Yantai as an example:

In a medical year (natural year), the medical expenses (excluding the expenses that will not be paid by the overall fund) of the on-the-job employees will be reimbursed by stages according to the hospital level:

A hospital, Qifubiaozhun above to the highest payment limit to pay 90%;

85% of the minimum deductible line 1 10,000 yuan (inclusive) and 90% of the maximum payment limit 1 10,000 yuan;

In tertiary hospitals, 80% will be paid for the part with the minimum deductible of 5,000 yuan (inclusive), 85% for the part with the minimum deductible of 5,000 yuan to 10000 yuan (inclusive), and 90% for the part with the maximum payment limit of 10000 yuan.

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

This paper not only explains the new policy of medical insurance payment period, but also tells you the proportion of 20 17 employee medical insurance reimbursement scope for your reference. It should be pointed out that the standard of medical insurance years given in this paper is a reference value, which will vary according to different regions (such as the differences between Zhengzhou and Chongqing policies listed in this paper), and will be adjusted according to government policies in the future, which is not static.

Legal basis: Article 2 of People's Republic of China (PRC) Social Insurance Law The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance. To ensure citizens' right to receive material assistance from the state and society in accordance with the law in cases of old age, illness, work injury, unemployment and maternity.