Medical insurance in social security is a general term, but for different groups, it has different nature. Generally speaking, the proportion of employees' medical insurance reimbursement is much higher than that of urban residents and the new rural cooperative medical system, so it is more cost-effective to pay if conditions permit.
Compared with the medical insurance of urban residents and the new rural cooperative medical system, the coverage of employee medical insurance is larger. The money in the personal account of medical insurance can be freely controlled. As long as it is in the designated medical institutions that meet the reimbursement scope of employee medical insurance, they can spend by card. In the hospital outpatient service, in-patient, in the pharmacy purchase medicine and so on, with the medical insurance card may all real-time settlement.
After medical insurance, if the employees are on-the-job, after going to the outpatient and emergency department of the hospital, the medical expenses of more than 2000 yuan can be reimbursed, and the reimbursement proportion is 50%. For retirees under the age of 70, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, 80% of the expenses above 1300 yuan can be reimbursed. No matter what kind of people, the maximum amount of medical expenses for outpatient and emergency department is 20000 yuan.
The specific reimbursement scope of employee medical insurance is as follows:
1. Medical expenses incurred during the period when the new insured has not issued the social security card;
2. The medical expenses incurred during the period of reporting the loss of the social security card and making up (replacing) the social security card;
3. Expenses incurred in emergency treatment without card holder in designated medical institutions;
4. Medical expenses incurred during the period of arrears;
5. Medical expenses incurred during the period of manual reimbursement;
6. Expenses incurred when seeking medical treatment in a foreign port that meets the payment conditions of the city's medical insurance fund;
7. The annual expenses must be reported before January 20 of the following year.
What is the reimbursement rate of employees?
The proportion of hospitalization reimbursement of employee medical insurance:
1. For the first-class hospitals, 90% of the payment from the initial payment standard to the maximum payment limit shall be paid;
2. In the secondary hospital, 85% of the payment from the minimum payment standard to 10000 yuan (inclusive) and 90% of the part from 10000 yuan to the maximum payment limit;
3. In the tertiary hospitals, 80% of the payment from 5000 yuan (inclusive), 85% from 5000 yuan to 10000 yuan, and 90% from 10000 yuan to the maximum payment limit.
4. Retirees should increase 5% on the basis of the above payment proportion.
It should be noted that the regulations in each region may be different, and the reimbursement proportion and other terms may not be completely consistent. You can refer to the provisions of your local social security bureau or hospital.