What is the proportion of medical insurance reimbursement in Beijing?

The reimbursement rate in Beijing ranges from 85% to 97%, and the law is that the lower the hospital level, the higher the reimbursement rate. The higher the hospitalization expenses, the higher the reimbursement ratio. However, the large subsidy for hospitalization is an exception, accounting for 85%. In addition, the recently established medical service fee adopts a fixed reimbursement system, which will give corresponding fixed subsidies according to the selected hospital level and doctor level.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

1, the principle of supplementary medical insurance reimbursement is that the part that is not reimbursed by social security is reimbursed from supplementary medical care. For example, the part within outpatient service 1800 and the part outside social security reimbursement 1800, the part within hospitalization 1300 and the part outside social security reimbursement 1300.

2. The reimbursement amount of supplementary medical care depends on the company's own choice. For example, in addition to social security reimbursement, outpatient units can choose to reimburse 60%, 80% or even 90%, and hospitalization is the same. They can choose to reimburse 90%, 95%, etc. after reimbursement, and choose the proportion when insuring.

Beijing supplementary medical insurance benefits:

1, outpatient and emergency medical expenses

The following medical expenses that meet the reimbursement scope of basic medical insurance shall be paid by the supplementary medical insurance of the unit:

(1) Among the medical expenses accumulated in outpatient and emergency departments exceeding 1300 yuan, the personal burden of retirees is higher than 5%, and that of employees is higher than 10%, which shall be paid by the unit's supplementary medical insurance.

(2) Outpatient and emergency medical expenses shall be paid by the medical insurance fund to 2 yuan, and the rest shall be paid by the insured in cash, and no supplementary medical insurance shall be paid by the unit. The insured in the field of outpatient and emergency medical expenses is lower than that of 2 yuan, paid in full by the medical insurance fund.

2, hospitalization medical expenses

For the medical expenses below hospitalization Qifubiaozhun, the personal burden of retirees is higher than 5%, and the personal burden of employees is higher than 10%, which shall be paid by the unit's supplementary medical insurance.

For medical expenses above Qifubiaozhun, the part of retirees whose personal burden is higher than 3% shall be paid by the unit's supplementary medical insurance. The basic medical insurance reimbursement part of the personal burden is less than 3%, according to the basic medical insurance policy.

For medical expenses above Qifubiaozhun, 6% of the employees' personal burden will be paid by the unit's supplementary medical insurance. The basic medical insurance reimbursement part of the personal burden is less than 6%, according to the basic medical insurance policy.

Emergency observation fees and medical expenses for special disease clinics (radiotherapy and chemotherapy for malignant tumor, renal dialysis, aplastic anemia, hemophilia, renal transplantation, liver transplantation and anti-rejection treatment after combined liver and kidney transplantation) shall be implemented according to hospitalization standards.

Second, the concept of medical pants mode answers risks

Medical insurance refers to the basic medical insurance premium paid in full and on time by employers and employees according to the principle of compulsory social insurance through national legislation. If it is not paid in full and on time, the basic medical insurance fund for its medical expenses will not be paid, regardless of personal accounts. Take the proportion of medical insurance payment in Beijing as an example: the employer pays 65,438+00% of its total payment base every month, and the individual employee pays 2%+ 120 yuan as a serious illness co-ordination.

Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth. For example, free medical care and labor insurance medical care in China. The medical expenses of employees in China are shared by the state, units and individuals to reduce the burden on enterprises and avoid waste. Insurance liability accidents need to be handled, and the insurance money will be paid in proportion.

The above is the proportion of Beijing medical insurance reimbursement that Bian Xiao told you by taking Beijing as an example. As can be seen from the above, the reimbursement ratio of Beijing medical insurance is specifically stipulated according to the difference between outpatient service and hospitalization. Moreover, in order to protect the interests of Beijing residents, Beijing has also added some reimbursement items. In fact, the proportion of medical insurance reimbursement in all parts of the country is similar, but the reimbursement items supplemented by Hu Huiping are different according to their own economic conditions.