Proportion of reimbursement for serious illness medical insurance for employees in Shanghai

Measures for reimbursement of medical insurance for serious illness of employees

Payment standard and payment time of medical insurance for serious illness of employees

Medical insurance for employees with serious illness: The unit excludes 6% of the average monthly salary of employees in this city in foreign-invested enterprises in the above years, and pays the overall medical expenses for serious illness on a monthly basis according to the number of employees in the unit. Employees shall pay the medical insurance premium for serious illness on a monthly basis at 1% of the average monthly salary of employees in this city in the previous year, which shall be withheld and remitted by the unit; According to document [1998] 102, all units participating in serious illness medical insurance will pay serious illness medical insurance premium from 1 July 998 1 day, and units established after1July 9981day will pay serious illness medical insurance premium from the month when the business license is issued.

Serious illness medical insurance for employees of foreign-invested enterprises: 2.5% of the average monthly salary of employees of foreign-invested enterprises in the previous year, and the overall medical expenses for serious illness shall be paid monthly according to the number of Chinese employees in the enterprise. Employees and retirees pay the overall medical expenses for serious illness on a monthly basis, accounting for 1% of the average monthly salary of employees in the city last year. When the average monthly salary of enterprise employees is lower than 10% of the average monthly salary of employees in the whole city, it shall be calculated as 90% of the average monthly salary of employees in the whole city.

Scope of reimbursement for serious illness of employee medical insurance

Employees and retirees are sick or injured at work, and the one-time hospitalization medical expenses or accumulated 30-day medical expenses exceed 2,000 yuan, which belongs to the scope of reimbursement for serious illness of employees' medical insurance. The specific medical insurance reimbursement expenses of employees with serious illness include hospitalization expenses, emergency rescue and observation medical expenses within 7 days before hospitalization, radiotherapy and chemotherapy for malignant tumors, renal dialysis and anti-rejection outpatient medical expenses after organ transplantation. Medical expenses that are not covered by employee's medical insurance for serious illness include: medical expenses incurred in non-designated hospitals without referral procedures, occupational diseases, recurrence of work-related injuries or old injuries, traffic accidents, injuries caused by my own violation of the law, food poisoning, suicide, medical accidents, etc. And other medical expenses that should be taken care of according to national and local regulations. Standard for reimbursement of serious illness in employee medical insurance The reimbursement expenses for serious illness in employee medical insurance shall be calculated by stages and paid cumulatively. The specific reimbursement standard of employee's serious illness medical insurance is: 1 to 2,000 yuan (excluding 2,000 yuan) to 5,000 yuan, and 90% of the expenses within the reimbursement scope; 2, more than 5000 yuan (excluding 5000 yuan) 1 ten thousand yuan, pay 85% of the expenses within the scope of reimbursement; For expenses within the reimbursement scope, 1 10,000 yuan (excluding 1 10,000 yuan) but not exceeding 30,000 yuan, 80% shall be paid; 4, 30 thousand yuan (excluding 30 thousand yuan) but not more than 50 thousand yuan, the scope of payment is 85% of the scope of reimbursement; More than 50 thousand yuan (excluding 50 thousand yuan), 90% of the expenses within the scope of reimbursement.

Payment limit for reimbursement of employee's serious illness medical insurance

For the reimbursement payment limit of medical insurance for employees with serious illness, the standards are different in different parts of China due to different levels of local economic development. However, in recent years, in order to fundamentally solve the problem of "poverty caused by illness and returning to poverty due to illness" and improve the medical security level of the broad masses of employees, all provinces and cities across the country have greatly increased the reimbursement payment limit of medical insurance for serious illness of employees, from tens of thousands of yuan at the beginning to hundreds of thousands or even hundreds of thousands of yuan. For example, the maximum payment of medical insurance for employees with serious illness in Beijing has increased from 6.5438+0.7 million to 300,000 now, and the annual payment limit of medical insurance for employees with serious illness in Nanchang has increased to 320,000. Wuxi has realized the policy of not capping the reimbursement of medical insurance for employees with serious illness.

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