First, the scope of medical insurance reimbursement for enterprise employees
Outpatient and emergency medical expenses;
The cost of purchasing drugs at designated retail pharmacies;
Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund;
Medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.
The employee medical insurance fund shall reimburse the following medical expenses:
Hospitalization medical expenses;
Emergency rescue observation and income hospitalization, medical expenses within 7 days before hospitalization observation;
Outpatient medical expenses of taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.
The contribution ratio of medical insurance for enterprise employees is: 8% of the unit contribution base and 2% of the individual contribution base of employees.
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. 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 addition, following September 1, Beijing also announced the medical insurance payment standard for 20 16 years:
The amount of individual contributions for urban elderly is 360 yuan per person per year;
The individual payment amount of students and children is 160 yuan per person per year;
Individual contributions of urban unemployed residents are 660 yuan per person per year, and individual contributions of disabled unemployed residents are 360 yuan per person per year.
2. What is the reimbursement rate?
Answer from reimbursement ratio, general outpatient reimbursement, serious illness reimbursement and other aspects.
1.20 16 reimbursement ratio of medical insurance for enterprise employees
(a) according to the first payment, in the implementation of the basic drug system, 80% of the hospitalization expenses are paid (90% of the basic drug payment), and 60% of the hospitalization expenses are paid in the implementation of the basic drug system; Secondary hospitals pay 58%; The tertiary hospital pays 45%.
(2) According to the second payment, the first-level hospital pays 85% (90% for essential drugs), the second-level hospital pays 70%, and the third-level hospital pays 60%.
(three) minor residents and special groups enjoy the medical insurance benefits of class II payment.
Qifubiaozhun for reimbursement of hospitalization medical expenses: 300 yuan, a first-class hospital, 500 yuan, a second-class hospital and 700 yuan, a third-class hospital. Malignant tumor patients who have been hospitalized for chemotherapy and radiotherapy for many times in a medical insurance year will only be deducted once.
2.2065438+2006 reimbursement ratio of outpatient medical insurance for enterprise employees
Insured workers in designated community health service centers or township hospitals in accordance with the provisions of the outpatient medical expenses, paid by the general outpatient co-ordination fund according to the proportion of 50%. There is no deductible for the general outpatient expenses incurred by the insured workers in the basic medical institutions that implement the national basic drug system; In other primary medical institutions, the minimum payment standard was reduced from 40 yuan to 30 yuan. The reimbursement limit for the first-class general outpatient service was raised from 60 yuan to 80 yuan; The second payment was made in 200 yuan.
3.20 16 medical insurance benefits for critical illness
The deductible line of serious illness insurance in 20 15 years is 1 10,000 yuan, that is, after the reimbursement of residents' basic medical insurance, the part of the compliance medical expenses borne by individuals below 1 10,000 yuan will not be compensated. 50% compensation will be given to the part where the compliance medical expenses borne by individuals exceed 1 10,000 yuan (including 1 10,000 yuan) but less than 6,543,800 yuan; 65.438+10,000 yuan (including 6.5438+10,000 yuan) and 60% compensation for the part less than 200,000 yuan; More than 200,000 yuan (including 200,000 yuan) will be compensated by 65%. In a medical year, the maximum payment for serious illness insurance is 300,000 yuan per person. In 20 16 years, the standard of 20 15 was still implemented before the new critical illness insurance policy was issued by the relevant departments.
The above content is a specific introduction to the scope of reimbursement of medical insurance for enterprise employees. Therefore, the scope of medical insurance reimbursement for enterprise employees needs to go to designated medical institutions. The details are introduced in the above article. I hope everyone can use it effectively after understanding medical insurance, and at the same time, in order to make it easier for everyone to use it better, I have compiled the reimbursement ratio of medical insurance for enterprise employees for your understanding.