When you go to the doctor with your social security card in Beijing, do you get reimbursed the first time regardless of the cost? Or does it have to exceed a certain amount before it can be reimbursed

When you go to the doctor with your social security card in Beijing, do you get reimbursed the first time regardless of the cost? Or does it have to exceed a certain amount before it can be reimbursed?

Beijing with a social security card, no matter how many times the medical insurance reimbursement is reimbursement of the costs outside the starting line, below the starting line by the patient's self-payment, that is, less than 1,800 out-of-pocket expenses, more than 1,800 by the total amount minus 1,800 of the starting line, resulting in the remaining balance of the reimbursement rate. The starting line is not cumulative.

According to Article 36 of the Provisions of Beijing Municipal Basic Medical Insurance, medical expenses incurred by employees and retirees during a settlement period shall be calculated and paid in segments according to the level of the hospital and the amount of the expenses, and shall be shared by the basic medical insurance co-ordination fund and the individual in accordance with the following proportions:

(a) Medical expenses incurred in a tertiary hospital:

1. For the portion of the starting standard to 30,000 yuan, the coordinated fund pays 85% and the employee pays 15%;

2. For the portion exceeding 30,000 yuan to 40,000 yuan, the coordinated fund pays 90% and the employee pays 10%;

3. For the portion exceeding 40,000 yuan, the coordinated fund pays 95% and the employee pays 5%.

(2) Medical expenses incurred in secondary hospitals:

1. For the portion of the starting standard up to 30,000 yuan, the coordinated fund pays 87%, and the employee pays 13%;

2. For the portion of the amount exceeding 30,000 yuan up to 40,000 yuan, the coordinated fund pays 92%, and the employee pays 8%;

3. For the portion of the amount exceeding 40,000 yuan, the coordinated fund pays 97%, and the employee pays 3%.

(3) Medical expenses incurred in first-class hospitals as well as home hospital beds:

1. For the portion of the starting standard up to 30,000 yuan, the coordinated fund pays 90%, and the employee pays 10%;

2. For the portion of the amount exceeding 30,000 yuan up to 40,000 yuan, the coordinated fund pays 95%, and the employee pays 5%;

3. For the amount exceeding 40,000 yuan, the coordinated fund pays 97%, and the employee pays 3%;

4. pays 97% and the employee pays 3%.

(4) The individual payment rate for retirees is 60% of the employee's payment rate.

But the maximum amount to be paid by the Basic Medical Insurance Coordination Fund according to the proportion shall not exceed the maximum payment limit stipulated in Article 33 of these Regulations. When the payment ratio of the basic medical insurance fund listed in the first paragraph of this Article needs to be adjusted, the municipal labor security administrative department in conjunction with the municipal finance department shall put forward an adjustment plan and report it to the municipal people's government for approval before it is announced and put into effect.

Expanded Information:

"Beijing Municipal Basic Medical Insurance Provisions," Article 37, the establishment of the system of mutual assistance for large medical expenses. Mutual aid funds for large medical expenses shall pay, on a pro rata basis, for outpatient and emergency medical expenses incurred by employees and retirees in excess of a certain amount in a single year, as well as for medical expenses incurred in excess of the maximum payment limit of the Basic Medical Insurance Coordination Fund (excluding the portion below the starting standard and the portion borne by the individual).

Employers and their employees and retirees participating in basic medical insurance shall participate in the mutual aid for large medical expenses, except for those employers and their employees and retirees who are subject to the medical subsidy scheme for state civil servants. Mutual aid for large medical expenses is formulated by the municipal labor security administrative department in conjunction with the municipal finance department.

Baidu Encyclopedia - Beijing Municipal Basic Medical Insurance Regulations