Employee medical insurance reimbursement standard and proportion

Employee medical insurance treatment method hospitalization starting standard:

1, third level including more than three hospitals: 700 yuan within a year multiple hospitalization starting payment in order of 500 yuan, 400 yuan, 300 yuan;

2, second level including second level of specialized hospitals: 600 yuan within a year multiple hospitalization starting payment in order of 400 yuan, 300 yuan, 200 yuan;

3, Level I including the following hospitals: 500 yuan within one year multiple hospitalization starting payment in order of 300 yuan, 200 yuan, 100 yuan.

Employee outpatient reimbursement rate of forty-five to seventy percent.

The general outpatient reimbursement rate for working employees is 70% for first-level medical institutions including township health centers and community health centers, 60% for second-level medical institutions, and 45% for third-level medical institutions, and the reimbursement rate for retirees is increased by 5% according to the level of the medical institutions; the starting line of the outpatient treatment of Xi'an City Employee's Health Insurance is 200 yuan; the maximum payment limit of the outpatient treatment for working employees is The annual maximum payment limit is 2,500 yuan for retirees. The annual maximum payment limit is valid for the current year and does not roll over or accumulate.

Medicare reimbursement rates:

Medicare reimbursement rates are based on local policies and regulations, and may vary from region to region. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1, the basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion of the medical insurance fund to pay, generally ranging from 70% to 80%;

2, the individual out-of-pocket ratio: the individual out-of-pocket ratio refers to the proportion of the medical expenses that the individual needs to bear, generally ranging from 20% to 30%.

Medical insurance reimbursement process:

1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their own treatment items belong to the scope of reimbursement of medical insurance;

2, collection of reimbursement materials: collection of the relevant records of treatment, drug receipts, medical cost lists and other related materials;

3, the social security department to handle the reimbursement: submit the relevant materials to the local social security department to handle the reimbursement.

4. Waiting for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receiving the reimbursement payment: after the audit is approved, you can receive the reimbursement payment of the medical insurance at the designated bank.

In summary, the reimbursement rate of medical insurance in each region is different, urban and rural residents living in a different place for a long time, urban and rural residents of men aged 60 years old and women aged 55 years old, and urban and rural residents working in a different place, and students and children living with them, have applied for the record for the registration of medical treatment in a different place, in the registration for the record of the hospitalization of hospitalization in a place of hospitalization, the standard of the starting line of the standard for the first level of hospitals 400 yuan, the second level of 800 yuan, three levels The reimbursement rate is the same as that of the local designated hospital.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical services and facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.