What is the reimbursement rate of employee health insurance

The reimbursement rate of health insurance is as follows: for senior citizens over 70 years of age, other urban residents, students and children, for medical expenses under 100,000 yuan (180,000 yuan for students and children) which are eligible for reimbursement, the starting standard for tertiary hospitals is 500 yuan, and the reimbursement rate is 50% (55% for students and children); for secondary hospitals, the starting standard is 300 yuan, and the reimbursement rate is 60%; and the reimbursement rate for tertiary hospitals is 65%. The reimbursement rate is 65 percent for first-level hospitals.

Outpatient Reimbursement Ratio

After getting urban workers' basic medical insurance, if you are an active employee, you can only be reimbursed for medical expenses over 2,000 yuan after visiting outpatient and emergency clinics in hospitals, and the reimbursement rate is 50%. If you are a retiree under 70 years old, you can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70%. If the retiree is over 70 years old, expenses over $1,300 can be reimbursed the reimbursement rate is 80%. And no matter which category of people, the maximum amount of expenses paid for outpatient and emergency major medical expenses is 20,000 yuan.

For example, if you're an active employee and spend $2,500 on an outpatient visit, you can be reimbursed 50 percent of the $500 portion, which is $250.

Hospitalization reimbursement rates

The current starting amount is 1,300 yuan for the first time you use basic medical insurance to pay in a year, whether you are an active employee or a retiree. For the second and subsequent hospitalizations, the starting amount is set at 50%, which is 650 yuan. And the maximum payment from the Basic Medical Insurance Co-ordination Fund (for hospitalization expenses) in a year is currently 70,000 yuan.

Hospitalization starting standard

Tertiary including tertiary hospitals: 700 yuan within a year for multiple hospitalizations starting payment in order of 500 yuan, 400 yuan, 300 yuan employee health insurance reimbursement ratio 2016.

Second level including second level specialized hospitals: 600 yuan within a year for multiple hospitalizations starting payment in order of 400 yuan, 300 yuan, 200 yuan.

The first level including the following hospitals: 500 yuan within a year multiple hospitalization starting payment in order of 300 yuan, 200 yuan, 100 yuan.

Below the maximum payment limit above the starting line, Category A and general diagnosis and treatment fees for active employees pay 85%

Retirees pay: 90%. Class B drugs pay 75% high precision pay 70%.

Employee health insurance for chronic and special diseases, major diseases, the annual starting standard is 700 yuan. Category A and general diagnosis and treatment pays 80%, Category B is 75% highly refined 70%.

Reimbursement Scope

Medical expenses for outpatient and emergency treatment;

Expenses for purchasing medicines at designated retail pharmacies;

Medical expenses within 7 days of hospitalization prior to hospitalization for those who are rescued and retained in emergency and admitted to hospitalization;

Medical expenses for outpatient treatment of malignant tumors for radiation therapy and chemotherapy, renal dialysis, and anti-rejection medicines after renal transplantation.

The following items are excluded from the reimbursement of urban workers' medical insurance:

(I) Service item category.

(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.;

(2) special medical services such as consultation fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, and self-invited special nurses.

(2) The category of non-disease treatment programs.

(1) all kinds of beauty, fitness and non-functional cosmetic and orthopedic surgery;

(2) all kinds of weight loss, weight gain, height increase program.

(3) Health checkups;

(4) Preventive and health care programs;

(5) Medical consultations and appraisals.

(3) Diagnostic and treatment equipment and medical materials

Employee production, outpatient and inpatient medical expenses reimbursement ratio is different, and they both have a starting standard, over which medical expenses can be reimbursed. Not all medical items are eligible for reimbursement, such as spending on cosmetic items, medical checkups and medical appraisals, which are not reimbursed by health insurance.

Legal basis:

Article 28 of the Social Insurance Law

Medical expenses that are in accordance with the basic medical insurance drug list, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.