What's the reimbursement rate for employees?

First, the proportion of employee social security hospitalization reimbursement

1, level 1 hospital, 90% for the part above the minimum threshold;

2, secondary hospitals, Qifubiaozhun to 10000 yuan (inclusive) to pay 85%, more than 10000 yuan to pay 90%;

3, tertiary hospitals, Qifubiaozhun to 5000 yuan (inclusive) of the part by 80%, 5000 yuan to 1 ten thousand yuan of the part by 85%, 1 ten thousand yuan of the highest payment limit by 90%;

4. Retirees will increase by 5% on the basis of the above payment ratio.

2. What is the contribution ratio of enterprise employee medical insurance?

Units pay by 8% of the base pay, and employees pay by 2% of the base pay. However, it should be reminded that the base of employee medical insurance payment in different provinces and cities is different. Taking Guangzhou as an example, in 20 17424, the base of medical insurance payment for employees in Guangzhou was adjusted from 1856 1 yuan, and the lower limit was adjusted from 3485 yuan to 37 12 yuan. In addition, the payment base for flexible employees to participate in social medical insurance for employees is 60% of the average monthly salary of employees in this city last year, that is, 37 12 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. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.

3. What is the proportion of medical insurance reimbursement for retired employees?

1, outpatient and emergency medical expenses: the medical expenses that met the requirements of the basic medical insurance in that year (1 10/February/31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3, in the deductible above the maximum payment limit below the basic medical insurance payment scope of hospitalization medical expenses, class A drugs and general medical expenses paid by the on-the-job personnel as a whole fund 85%, retirees as a whole fund to pay 90%; 75% of the cost of Class B drugs is paid by the overall fund; 70% of the cost of high-tech examination and treatment is paid by the overall fund.

4. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

5. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

Four, residents' medical insurance payment policy

1, the individual payment standard will be adjusted appropriately. With the improvement of medical consumption level, the state's financial subsidy for residents' medical insurance has increased year by year, and the individual payment standard of 20 18 will also be raised appropriately. The payment standards are 100 yuan for students and children 60 yuan, elderly residents over 60 years old and other unemployed urban residents 300 yuan, which are increased by 10 yuan, 30 yuan and 100 yuan respectively. The subsistence allowances, the disabled and the "three noes" individuals still don't have to pay.

2, the newborn medical expenses to achieve "retrospective" reimbursement. According to the new policy, newborns pay residents' medical insurance within 90 days (including 90 days) from the date of birth, and the medical expenses for hospitalization due to illness from the date of birth can be paid by the medical insurance fund according to regulations.

3. Outpatient booking institutions cannot "bind without authorization". From 20 18 65438+ 10/0/day, the insured residents can enjoy the overall treatment of outpatient service for the first time with the medical certificate. There is no need to make an appointment in advance, and the outpatient appointment institution shall not "bind without authorization" against the wishes of the insured residents.

legal ground

Social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

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.