1, the standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. If you live in a tertiary hospital, the employee pays 15%, which is 85% of the reimbursement, from the minimum threshold to 30,000 yuan.
2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;
3, more than 40000 yuan to the maximum payment limit, 95% can be reimbursed, employees only need to pay 5%.
4. The individual contribution ratio of retirees is 60% of the on-the-job (i.e. the above) employees, but all below the threshold is paid by individuals.
Second, what is the reimbursement method?
The reimbursement method is simple. Take your ID card and medical insurance card to the local designated hospital for medical treatment and pay the deposit. When you leave the hospital, you should pay for it yourself and deduct it from the deposit or medical insurance card. If the medical insurance is reimbursed, it will be settled by the medical insurance and the hospital, and the insured person does not need to pay for it himself.
How much can employee medical insurance surgery be reimbursed?
It was learned from the Medical Insurance Center of the People's Social Security Bureau that within the scope of medical insurance, the proportion of the insured's hospitalization medical expenses for one year above the deductible line and below 60,000 yuan was 6% in the first-class hospital, 8% in the second-class hospital and 10% in the third-class hospital. For retirees and employees who have worked for more than 30 years, the proportion of individual commitment will be halved.
600,000-300,000 yuan shall be borne by 4% of individuals, and some funds above 300,000 yuan shall not be paid.
1. What is the threshold fee for hospitalization?
Answer: The insured person should take his social security card to the designated medical institution for the first time. Within the scope of medical insurance, the Qifubiaozhun for hospitalization in the first-class (and below), second-class and third-class hospitals in this city are 200 yuan, 400 yuan and 600 yuan respectively.
2. What is the proportion of reimbursement for hospitalization medical expenses?
Answer: Within the scope of medical insurance, within one year, the proportion of the insured's hospitalization medical expenses above the threshold and below 60,000 yuan is 6% in the first-class hospital, 8% in the second-class hospital and 10% in the third-class hospital. For retirees and employees who have worked for more than 30 years, the proportion of individual commitment will be halved. 600,000-300,000 yuan shall be borne by 4% of individuals, and some funds above 300,000 yuan shall not be paid.
3. How is the medical insurance medicine prescribed in hospital prescribed?
Answer: According to the List of Drugs for Basic Medical Insurance and Work Injury Insurance in Anhui Province, the drugs used by the insured in hospital are divided into Class A drugs and Class B drugs. The expenses incurred in using Class A drugs shall be paid according to the provisions of basic medical insurance. For the use of Class B drugs, the insured pays a certain proportion first, and the rest is paid according to the provisions of basic medical insurance. The use of drugs outside the drug list will not be reimbursed by the medical insurance fund.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services.