The maximum reimbursement limit for outpatient service in Beijing is 20,000 yuan, and the basic reimbursement value for hospitalization is 6,543,800 yuan. Plus a large subsidy of 200,000 yuan for hospitalization, the maximum reimbursement limit can reach 300,000 yuan. In other words, Beijing's medical insurance can help bear the treatment cost of up to 300,000 yuan. Therefore, according to different medical types, the reimbursement policies given by the state are different. Generally speaking, the upper limit of reimbursement for community outpatient service is the largest, reaching 90%, and most hospitalization expenses can also be reimbursed for hospitalization.

Specific reimbursement policies for different types of medical care in Beijing;

I. Restrictions

The maximum compensation limit for employees has been raised to 300,000.

For the hospitalization expenses of employees participating in basic medical insurance, the annual maximum payment limit of medical insurance is adjusted from 6,543.8+0.7 million yuan to 300,000 yuan, of which: the maximum payment limit of basic medical insurance pooling fund is adjusted to 6,543.8+0.8 million yuan; The maximum payment limit of large medical mutual fund is adjusted to 200,000.

The policy adjustment is based on national requirements: the maximum payment limit of medical insurance for urban workers is raised to about 6 times the average annual salary of local workers.

Second, hospitalization.

The reimbursement rate of large medical expenses for employees in hospital has increased to 85%

Increase the reimbursement rate of hospitalization medical expenses exceeding the maximum payment limit of the basic medical insurance pooling fund. Among them, the reimbursement rate of employees was adjusted from 70% to 85%, and that of retirees was adjusted from 85% to 90% (including supplementary medical insurance for retirees). The adjustment of reimbursement ratio will improve the level of individual medical treatment, especially the large medical treatment for on-the-job employees by about 20%.

The above two policies will greatly improve the level of medical treatment for people with serious illness or high medical expenses, and greatly reduce the burden of large medical expenses for insured people.

Third, the community

The reimbursement rate of community outpatient service is 90%.

Through policy adjustment, the reimbursement rate of community outpatient medical expenses for on-the-job employees and retirees will be increased to 90%. Among them, the proportion of reimbursement for outpatient medical expenses of on-the-job employees in community health institutions in this city was adjusted from 70% to 90%; The proportion of reimbursement for outpatient medical expenses of retirees under 70 years old who seek medical treatment in community health institutions in this Municipality has been adjusted from 85% to 90% (including supplementary medical insurance for retirees).

Fourth, outpatient service.

Staff hospital outpatient

The reimbursement rate is increased to 70%

The proportion of reimbursement for outpatient medical expenses in other designated medical institutions except community health institutions in this city has been adjusted from 50% to 70%. This policy belongs to the adjustment of GSP policy, and the medical insurance benefits will be increased by about 40%, involving about 5.6 million employees.

Article 29 of the Social Insurance Law, the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.