Reimbursement policy of medical insurance for employees in Jinan city

Proportion of medical insurance reimbursement for employees in Jinan

1. Qifubiaozhun-10000 yuan: 85% from the medical insurance pooling fund and15% from the individual;

2. 10000 -90000 yuan: 88% from the overall fund, 12% from individuals;

3. Reimbursement for serious illness medical insurance is 90-200,000 yuan: 90% for large medical assistance and 0/0% for individual/kloc.

Proportion of medical insurance reimbursement for retired employees in Jinan

For the part above 1. Qifubiaozhun and below 10000 yuan, the overall fund burden is 85%, and the personal burden is15%;

2. 10000 yuan to the maximum payment limit, the overall fund burden is 88%, and the personal burden is 12%.

Medical insurance for employees is medical insurance for urban employees. The basic medical insurance premium for medical insurance for urban employees shall be paid jointly by the employer and the employees.

The basic medical insurance fund consists of overall funds and individual accounts.

The basic medical insurance premiums paid by individual employees are all included in individual accounts.

Jinan medical insurance reimbursement conditions:

1, hold a card for hospitalization, register a social security card for admission, and go through the reimbursement procedures directly when you are discharged from hospital.

2. The insured who is hospitalized without a card needs to be hospitalized during the period without a card. It is necessary to bring a letter of introduction from the unit and a copy of the admission certificate to the Medical Insurance Department of the Urban Workers of the Municipal Social Security Bureau to issue a certificate without a card before going through the hospitalization formalities. When you leave the hospital, you will not settle the account for the time being, and then you will take the card to the hospital where you live to handle the expense settlement procedures.

The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall fund, and the other part is included in the personal account. The proportion of individual accounts is generally about 30% of the employer's contributions, and the specific household proportion is determined by the overall planning area according to the scope of individual account contributions and the age of employees.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

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.