Beijing medical insurance reimbursement deductible line

Beijing Medical Insurance Reimbursement: In outpatient reimbursement, the deductible line is 1.800 yuan for active employees and 1.300 yuan for retired employees; The deductible standard of hospitalization reimbursement varies according to the number of reimbursement. In a medical insurance year, the first deductible line is 1300 yuan; The threshold for the second reimbursement is 650 yuan.

All medical expenses incurred by Beijing medical insurance participants can be reimbursed accordingly, but not all medical expenses are within the scope of medical insurance reimbursement. Participating in different types of medical insurance and choosing different medical institutions will have an impact on the amount of medical insurance reimbursement. Payment scope of individual medical insurance account of Beijing Medical Insurance:

1, outpatient and emergency medical expenses.

2, to the designated retail pharmacies to buy drugs.

3, the basic medical insurance fund Qifubiaozhun the following medical expenses.

4, more than the basic medical insurance fund Qifubiaozhun part, according to the proportion that should be borne by the individual medical expenses. The insufficient part of personal account shall be paid by myself.

Proportion of medical insurance reimbursement in Beijing:

For on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed after the emergency treatment in the hospital, and the reimbursement rate is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.

No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

In case of hospitalization expenses, employees and retirees should pay the minimum amount 1300 yuan when using the basic medical insurance for the first time in a year. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 yuan.

Beijing Medical Insurance Reimbursement Process:

1. When the insured goes to the designated hospital, he must carry the barcode "Beijing Medical Insurance Manual";

2. When you go to a designated hospital for medical insurance reimbursement, you should check the insured person's handbook, collect the basic information of the insured person through the barcode in the handbook, issue a medical expense bill issued by the outpatient (emergency) consultation for this reimbursement, and upload the outpatient expenses of the insured person to the medical insurance information system in time and accurately;

3. After seeing a doctor, the insured shall keep the prescription, outpatient receipt (outpatient invoice), detailed list and other relevant information, and submit it to the unit or social security office for reimbursement of medical expenses in time;

4. After receiving the outpatient (emergency) medical expenses declared by the unit and social security, the county medical insurance center will compare the relevant materials with the electronic information uploaded in the medical process, and reimburse the medical expenses that meet the requirements of basic medical insurance;

5. After reimbursement, the retiree directly transfers money to the insured's personal passbook through the bank, and the reimbursement form is sent to the individual through the post office. On-the-job employees are paid by the unit.

Beijing medical insurance reimbursement needs materials:

1, social security card (provided by the insured with social security card);

2, outpatient and emergency prescription bottom side (in case of emergency need emergency prescription bottom side);

3. The injury expenses shall provide the cause of injury, and affix the official seal of the unit and the emergency department;

4. Original machine-printed bill (stamped with financial seal);

5. Detailed list of inspection, treatment, materials and laboratory expenses;

6, Beijing medical insurance referral (hospitalization) form (provided by the referral staff);

7. Original emergency diagnosis certificate;

8, "Beijing medical insurance handbook participation fee audit table" or "Beijing medical insurance outpatient upload fee audit table";

9. List of Manual Reimbursement Expenses of Beijing Basic Medical Insurance or List of Uploading Expenses of Beijing Basic Medical Insurance Outpatient;

10, provide materials (general electronic files are also acceptable).

legal ground

Provisions of Beijing Municipality on Basic Medical Insurance

Thirty-sixth medical expenses incurred by employees and retirees in a settlement period shall be calculated by stages and paid cumulatively according to the level of the hospital and the amount of expenses, and shall be shared by the basic medical insurance fund and individuals according to the following proportions:

(1) Medical expenses incurred in tertiary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 85% will be paid by the overall fund and15% by the employees;

2. For the part exceeding 30,000 yuan to 40,000 yuan, 90% shall be paid by the overall fund and10% by the employees;

3 more than 40 thousand yuan, the overall fund to pay 95%, workers pay 5%.

(two) medical expenses incurred in secondary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 87% will be paid by the overall fund and13% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(3) Medical expenses incurred by first-class hospitals and family beds:

1. 90% of the minimum threshold is 30,000 yuan, and 90% is paid by the overall fund and10% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(4) The individual contribution ratio of retirees is 60% of the employees.

However, the maximum amount of proportional payment of the basic medical insurance pooling fund shall not exceed the maximum payment limit stipulated in Article 33 of these Provisions.

When the payment ratio of the basic medical insurance fund listed in the first paragraph of this article needs to be adjusted, the municipal labor and social security administrative department shall, jointly with the municipal finance department, put forward an adjustment plan, which shall be promulgated and implemented after being approved by the Municipal People's government.