Beijing medical insurance reimbursement is over-capped.

Let me explain it to you in detail.

If you participate in social security, there are at most three accounts: the overall fund account (belonging to public funds, everyone is the same), the large mutual aid account (whether it is established or not) and the personal account (the higher the payment salary, the higher the balance of the personal account). Under normal circumstances, the payment is shared by individuals and units. A freelancer like you may have to pay social security yourself.

Now let's look at the different functions of these three accounts-that is, the payment scope of the accounts.

The first is the overall fund. In general outpatient service, the overall fund is ignored. It mainly deals with reimbursement of special outpatient and hospitalization expenses. Reimbursement for special outpatient service refers to the reimbursement of treatment expenses arising from cancer radiotherapy and chemotherapy and uremia dialysis, excluding operation expenses. The reimbursement of hospitalization expenses refers to the reimbursement of general hospitalization expenses and the reimbursement of hospitalization expenses seven days before emergency.

Secondly, let's look at large-scale mutual assistance and general outpatient reimbursement. In the case of special outpatient service and hospitalization, large-scale mutual aid reimbursement is the cost that exceeds the upper limit of reimbursement of the overall fund within one year (the cost will be mentioned below).

Finally, personal accounts. As long as the personal account has a balance, it can be freely controlled. Generally speaking, you can spend your own money.

Now let's look at the reimbursement rules for each account.

The general outpatient service, special outpatient service and hospitalization of the overall fund are not reimbursed, and the provisions are: 85%-97% reimbursement, deductible line 1.300 yuan. The upper limit of annual cumulative expenses is 70,000 yuan. Its reimbursement ratio is inversely proportional to the level of the hospital and directly proportional to the number of drugs prescribed. The higher the cost, the higher the reimbursement ratio. Take tertiary hospitals in Beijing as an example, the medical expenses are 1, 300-3000, and the reimbursement rate is 85%. 30,000-40,000, and the reimbursement ratio is 90%; The reimbursement rate of more than 40 thousand yuan is 95%.

Large mutual aid, general outpatient deductible 2000 (equivalent to deductible), more than 2000 50%, the highest 20 thousand. Reimbursement for special outpatient service and hospitalization is the part where the expenses exceed the ceiling line of the overall fund (70,000), and it is reported as 70%, with a maximum of 65,438+10,000.

Personal accounts are discretionary. The monthly income of personal account is 2% of personal salary+0.8%-4.8% of enterprise personal salary.

In Beijing, the monthly income of personal accounts under the age of 35 is 2.8% of my salary; 35-44 is 3% of his salary; 45- retirement is 4% of his salary; Retirement -69 is 6.3% of his salary; More than 79 is 6.8%.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.