The lowest reimbursement ratio in Beijing is 85%, and the highest is 97%. The rule is that the lower the hospital level, the higher the reimbursement ratio. The higher the hospitalization expenses, the higher the reimbursement rate. However, the exception is the large hospitalization subsidy, which is 85%. In addition, the recently established medical service fee adopts a fixed reimbursement system, and a corresponding fixed amount of subsidy will be given according to the selected hospital level and physician level.

Legal basis: "Social Insurance Law of the People's Republic of China"

Article 30 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) Should be paid from the work-related injury insurance fund;

(2) Should be paid by a third party;

(3) Should be paid by the public health department ;

(4) Seeking medical treatment abroad.

Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.

1. The principle of supplementary medical insurance reimbursement is that the portion not reimbursed by social security will be reimbursed from supplementary medical care. For example, the part of the outpatient service within 1,800 and the part beyond the social security reimbursement ratio of 1,800 and above, the part of the hospitalization within 1,300 and the part beyond the social security reimbursement ratio of 1,300 and above.

2. The amount of supplementary medical reimbursement is determined by the unit’s choice. For example, outpatient units can choose to reimburse 60%, 80%, or even 90% in addition to social security reimbursement, etc. For hospitalization, Likewise, you can choose to reimburse 90%, 95%, etc. after declaring for reimbursement. The proportions are selected when applying for insurance.

Beijing supplementary medical insurance benefits:

1. Outpatient and emergency medical expenses

The following medical expenses that are within the scope of basic medical insurance reimbursement will be paid by the unit's supplementary medical insurance :

(1) For the part of outpatient and emergency medical expenses that exceeds 1,300 yuan in total during the year, the personal burden of retirees is higher than 5%, and the personal burden of active employees is higher than 10%, the unit will supplement medical expenses. Insurance is paid.

(2) Outpatient and emergency treatment fees will be paid at a fixed amount of 2 yuan from the medical insurance fund, and the remaining fees will be paid by the insured in cash. The unit's supplementary medical insurance will no longer pay. If an insured person incurs outpatient or emergency treatment expenses of less than 2 yuan in other places, the medical insurance fund will pay them in full.

2. Hospitalization medical expenses

Among the medical expenses below the hospitalization deductible standard, the personal burden of retirees is higher than 5%, and the personal burden of active employees is higher than 10%. The unit's supplementary medical insurance will pay for it.

The medical expenses above the minimum standard shall be paid, and the part of the retiree’s personal burden exceeding 3% shall be paid by the unit’s supplementary medical insurance. If the basic medical insurance reimburses part of the personal burden below 3%, the basic medical insurance policy will apply.

The medical expenses above the minimum standard are paid, and 6% of the employee's personal burden will be paid by the company's supplementary medical insurance. If the basic medical insurance reimburses part of the personal burden below 6%, the basic medical insurance policy will apply.

Expenses for emergency stays, outpatient medical expenses for special diseases (radiotherapy and chemotherapy for malignant tumors, renal dialysis, aplastic anemia, hemophilia, kidney transplantation, liver transplantation, anti-inflammatory drugs after liver-kidney combined transplantation) Rejection treatment) is performed according to hospitalization standards.

2. The concept of medical insurance

Medical insurance refers to the basic medical insurance premiums that shall be paid by the employer and employees through national legislation and in accordance with the principle of compulsory social insurance. Individuals pay in full and on time. If payment is not made in full and on time, the basic medical insurance pooling fund will not pay for medical expenses, regardless of personal account. Take the medical insurance payment ratio in Beijing as an example: the employer pays 10% of its total payment base every month, and the employee pays 2% of his salary + 120 yuan for serious illness.

Medical insurance is a type of insurance that compensates for medical expenses caused by diseases. Social insurance that provides necessary medical services or material assistance to employees due to illness, injury, or childbirth, provided by the society or the enterprise. Such as China's publicly funded medical care and labor insurance medical care. The medical expenses of Chinese employees are jointly borne by the state, units and individuals to reduce the burden on enterprises and avoid waste. If an insured accident requires treatment, the insurance premium will be paid in proportion.

The above is what the editor tells you about the reimbursement ratio of Beijing’s medical insurance, taking Beijing as an example. From the above, we can see that the reimbursement ratio of Beijing’s medical insurance is specifically stipulated according to different outpatient and inpatient conditions. In addition, in order to protect the interests of Beijing residents, Beijing has also added some reimbursement items. In fact, the reimbursement ratios of medical insurance are similar across the country, but the reimbursement items supplemented by Hu Huiping vary according to their own economic levels.

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