Legal subjectivity:

Medical insurance can also reimburse for medical treatment in other places, but the reimbursement rate of medical insurance in other places will be less than that in the local area.

1. How much is the reimbursement rate of medical insurance in other places

1. Outpatient and emergency medical expenses: within the year (January 1st to December 31st) for active employees, they comply with the provisions of basic medical insurance The accumulated medical expenses exceed more than 2,000 yuan.

2. Settlement ratio: During the contract period, 50% of the dispatched personnel's expenses exceeding 2,000 yuan will be reimbursed, and the individual will pay 50%; the maximum amount of outpatient and emergency reimbursement paid to dispatched personnel in one year is 20,000 yuan.

3. Insured persons must properly keep the outpatient medical receipts (including receipts for large amounts and below, the bottom of prescriptions, etc.) for medical treatment at designated hospitals as a voucher for medical expense reimbursement.

4. Outpatient medical treatment for three special diseases: when the insured person needs to seek medical treatment in an outpatient clinic after radiotherapy and chemotherapy for malignant tumors, renal dialysis, and kidney transplantation, the insured person shall The designated secondary and tertiary hospitals for medical treatment will issue a "Disease Diagnosis Certificate", fill out the "Medical Insurance Special Disease Application Approval Form", and report it to the district medical insurance center for approval and filing.

Outpatient medical treatment and medicine collection for these three special diseases are limited to approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred fall within the prescribed range for outpatient special diseases, they will be settled with reference to hospitalization.

5. Inpatient medical treatment. Only if you have paid enough medical insurance for 20 years can you enjoy medical insurance reimbursement after retirement.

2. How much do you need to pay for employee medical insurance every year

Generally speaking, in terms of employee medical insurance premiums, men have to pay for 25 years and women have to pay for 20 years. In this case, you can also enjoy medical reimbursement benefits after retirement. As for the payment standard, the annual payment amount is actually variable and depends on your salary base and payment level. So, there is no set amount.

Employee social security accounts are set up for individual accounts, which are mainly used for outpatient treatment at designated medical institutions and the purchase of medicines at designated retail pharmacies. Resident medical insurance does not set up individual accounts, and outpatient medical treatment is coordinated by outpatient services. As the medical insurance certificate of the insured person, there is no money in the medical insurance card. It only records the detailed information of the insured person and the payment and reimbursement status. It is recommended that you file it with the local Consult the Social Security Administration.

As for the amount of rebate, it is actually not fixed. Every employee has different medical insurance payment standards, so the money returned is also different. Also, generally speaking, only employee medical insurance can get money back, and individuals paying for medical insurance cannot get money back. Because individuals pay social security out of their own pocket and do not pay part of corporate contributions, no money is returned before retirement. Only after retirement can the money be returned to the card.

3. Scope of non-reimbursement by medical insurance

1. Failure to seek medical treatment in a designated hospital

The medical insurance card can only be used in designated hospitals, and medical insurance will reimburse you. If you fail to seek medical treatment in accordance with the designated medical institutions, medical insurance will not reimburse you. And the higher the level of medical treatment in a hospital, the lower the reimbursement rate will be.

2. Exceeding the reimbursement limit

After the unification of urban and rural residents’ medical insurance, real-time reimbursement of medical expenses has been realized. The reimbursement ratio is still the same as before, but there is a certain limit on the cumulative amount of reimbursement within a year. .

3. Special medical treatment

(1) Medical expenses for traffic accidents or work-related injuries due to personal reasons will not be reimbursed.

(2) Medical insurance will not reimburse medical expenses caused by drunk driving, drug abuse, theft, etc.

(3) Medical insurance will not reimburse medical expenses for miscarriage, abortion and other reasons due to personal reasons.

(4) Medical insurance will not reimburse medical expenses incurred due to plastic surgery, cosmetology, weight loss, etc.

4. Special treatment

Some medical projects will have special medical project funds, such as children's vaccinations. Some relevant institutions will vaccinate children for free. If parents pay for their children to be vaccinated at their own expense, it will not be covered by medical insurance, so medical insurance will not reimburse them.

Although the scope of medical insurance reimbursement is getting wider and wider, there are still cases where medical insurance will not reimburse. Therefore, everyone must understand the scope of medical insurance that cannot be reimbursed to avoid unnecessary trouble when reimbursing.

According to legal provisions, it can be known that the proportion of medical insurance reimbursement is related to many factors. The reimbursement situation is also different for different identities, and it is determined based on the actual situation. Legal objectivity:

Article 28 of the "Social Insurance Law"

Comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses, in accordance with the national Provides payment from the basic medical insurance fund.

Article 29

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit .

The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.