Upper limit of reimbursement for outpatient medical insurance in Beijing

1, the outpatient reimbursement capping line for on-the-job employees is 20,000 yuan, and the hospitalization capping line is 500,000 yuan. 2. Since 2002 1 and1,the maximum payment limit of the fund for outpatient and emergency medical expenses incurred by the participants in the basic medical insurance for urban and rural residents in a medical insurance year has been raised from 4,000 yuan to 4,500 yuan. Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. 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; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. With the characteristics of "low level and wide coverage", the payment is based on the cost that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees of different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "the burden of both parties and the combination of unified accounts"; Based on the principle of "balance of payments".

Legal basis:

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Derivative problem:

How to handle the transfer of medical insurance relationship

(1) Transfer out. The insured person applies for transfer to the social security agency in the new place of employment. After receiving the Contact Letter for the Transfer and Continuation of the Basic Medical Insurance Relationship, the social security agency in the new employment place will issue the Medical Insurance Certificate and the Information Form for the Change of the Insured's Medical Insurance Type to the other party to transfer the storage amount of the personal account of medical insurance.

(2) transfer. The employer or I hold an ID card and a copy, apply to the social security agency of our city for transferring the relationship of medical insurance in different places, fill in the application form for the relationship of basic medical insurance, and send the transfer letter of the relationship of basic medical insurance to the social security agency of the original insured place if it meets the transfer conditions. After receiving the medical insurance certificate sent by the other party, the insured person's medical insurance type change information form and personal account funds, continue the medical insurance relationship.