As we all know, medical insurance is an important part of the social insurance system, and the state has formulated relevant laws and regulations, which clearly stipulates the obligation of employers to pay medical insurance for employees. Among them, the cost of employee personal medical insurance is paid by both the unit and the employee.
First, the proportion of employees' personal medical insurance reimbursement
1, in a first-class and first-class hospital, the minimum threshold is 30,000 yuan, 90% of the basic medical insurance can be paid by the overall fund, and individual employees need to pay 10%. If the floating standard exceeds 30,000-40,000 yuan, its overall fund payment is as high as 95%, and individual employees only need to bear about 5%. If the minimum deductible is more than 40,000 yuan, the basic medical insurance pooling fund will pay 97%, and individual employees will pay 3%.
2, secondary hospitals, Qifubiaozhun 30000 yuan, 87% of the basic medical insurance can be paid by the overall fund, and the individual contributions of employees reach13%; If the medical expenses exceed 30,000-40,000 yuan, 92% can be paid by the overall fund, and 8% should be paid by individual employees; If the medical expenses exceed 40,000 yuan, the basic medical insurance can be paid by the overall fund up to 97%, and individual employees only need to pay 3%.
3. In tertiary hospitals, the minimum threshold is 30,000 yuan for medical expenses, 85% of basic medical insurance can be paid by the overall fund, and individual employees only need to pay15%; If the medical expenses exceed 30,000-40,000 yuan, 90% of the basic medical insurance can be paid by the overall fund, and individual employees only need to pay10%; If the medical expenses exceed 40,000 yuan, the overall fund can pay 95%, and individual employees only need to pay 5%.
4. Among them, the individual contributions of retirees only account for 60% of the contributions of employees.
Second, the prerequisite for reimbursement of employees' personal medical insurance
1. The applicant has gone through the insurance formalities and paid the medical insurance premium in full.
2, the insured medical expenses incurred in medical institutions, pay cash in advance, and save the relevant documents and materials.
3. Going to the designated medical institutions of cooperative medical care: the general outpatient and emergency expenses incurred by the insured in the designated medical insurance hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by individuals.
4. Prepare the original invoice: personal cash pays for general outpatient and emergency expenses, resulting in medical expenses within the three categories of medical insurance.
5. Bring the medical insurance card and my ID card: 65438+ 0-20th of each month. The expenses of the current month shall be declared in the following month, and the expenses of the current year shall be applied for reimbursement before 1-20 of the following year.
6. The insured person submits the documents to the unit or social security office, and the unit or social security office enters the documents into the enterprise version, and then declares the electronic information and documents to the medical insurance center.
Once an employee is sick, he needs medical insurance reimbursement. The reimbursement ratio of general medical insurance varies according to the level of medical care and the amount of medical expenses. The above is the relevant content of the reimbursement ratio of employees' personal medical insurance, and I hope it will help everyone. If you still don't understand, you can consult relevant lawyers online.
Legal objectivity:
Article 26 of the Measures for the Administration of Basic Medical Insurance for Urban Employees in Nanchang City, if the employing unit handles the first insurance for employees and pays the basic medical insurance premium for urban employees in full and on time, it shall enjoy the basic medical insurance benefits stipulated in these Measures from the next month of payment 1 day. If the insured employer fails to pay in full and on time, its employees' basic medical insurance benefits will be suspended from the following month 1.