1. Is there an upper limit for medical insurance reimbursement?
There is an upper limit on the amount of medical insurance reimbursement. Social basic medical insurance is divided into two categories, medical insurance for urban workers and medical insurance for urban and rural residents. The reimbursement limits of these two kinds of social medical insurance do not mean that there is a limit on the amount of hospitalization each time, but there is a limit on the natural year. In China, the reimbursement limit of medical insurance has local regulations, which is not uniform throughout the country.
1, medical insurance for urban workers
Maximum annual reimbursement for outpatient service: 20,000 yuan.
Deductible: On-the-job personnel 1.800 yuan, with the reimbursement rate starting from 70%. Retirees 1300 yuan, the reimbursement rate is 85%.
Upper limit of annual reimbursement for hospitalization: 300,000 yuan.
Deductible line: No matter whether employees or retirees are hospitalized for the first time1.From 300 yuan, the reimbursement rate is 85%. Second hospitalization, since 650 yuan, reimbursement rate: 85%.
Major diseases: The part of self-paid medical expenses that exceeds the per capita disposable income of urban residents in this city last year shall be calculated by stages and paid cumulatively. Under 50,000 yuan, the reimbursement rate starts from 50%, and over 50,000 yuan, the reimbursement rate starts from 60%, with no upper limit.
2. Medical insurance for urban and rural residents
Upper limit of annual reimbursement for outpatient service: 3000 yuan.
The deductible line: level-1 hospital 100 yuan, and the reimbursement rate is 55%. Reimbursement rate from 550 yuan, 50% for hospitals of level 2 and above.
Hospitalization: 200,000.
Deductible: 75% for children 150 yuan and adults in 300 yuan.
Remarks: The above expenses do not include expenses not included in medical insurance, such as out-of-pocket expenses and self-funded items. Also, the registration fee (medical service fee) is not included in the deductible line and the capping line.
Two. Types that cannot be reimbursed
(1) expense category
Non-clinically necessary and uncertain treatment items and special medical services, such as: registration fee, out-of-hospital consultation fee, case fee, home visit fee, emergency treatment fee, name-calling operation surcharge, special medical service, health examination fee, weight loss, weight gain, additional items, medical consultation, medical appraisal, bed fee, ambulance fee, myopia orthopedic surgery, magnetic therapy and cosmetic surgery.
(2) Situational category
Seeing a doctor in a non-designated hospital, except for emergency treatment, buying medicine in a non-designated retail pharmacy, suffering from occupational diseases, work-related injuries, traffic accidents, medical accidents or other accidental injuries. Medical expenses incurred due to drug abuse, fighting, suicide, self-mutilation, alcoholism, etc., which are stipulated by other countries and Beijing to be borne by individuals.
To sum up, we can know that there is an upper limit on the amount of medical insurance reimbursement. If you have other questions to answer, you can come for detailed consultation.