The cap for hospitalization in Beijing is 500,000 yuan.

The hospitalization reimbursement ratio for active employees in Beijing is over 85%, and the hospitalization reimbursement ratio for retirees is over 90%, up to 99.1%, with a hospitalization ceiling of 500,000 yuan.

Starting from January 1, 2021, the maximum fund payment limit for outpatient and emergency medical expenses incurred by urban and rural residents' basic medical insurance participants in a medical insurance year will be increased from 4,000 yuan to 4,500 yuan.

1. Medical insurance is divided into two accounts. The personal account, the money reflected in the medical insurance card, can be used to buy medicines at designated pharmacies, pay for outpatient expenses and the personal out-of-pocket portion of hospitalization expenses; the overall account is managed by the medical insurance center

, the expenses incurred by the insured that are eligible for local medical insurance reimbursement will be paid from the overall account.

2. When seeking medical treatment (hospitalization), present the medical insurance card to the designated hospital to prove the insured status. When checking out, the individual's self-paying part shall be paid by the individual with the medical insurance card or cash, and the part reimbursed by the medical insurance shall be paid by the medical insurance and

For hospital settlement, individuals do not need to pay first and then be reimbursed.

The medical expenses incurred in outpatient clinics are not reimbursable.

Social medical insurance reimbursement: 1. Different medical insurance reimbursement ratios are different in different hospitals. If a person spends 10,000 yuan in the hospital, if he is treated in a first-level hospital, then 500 yuan will be deducted first; if he is treated in a second-level hospital, the reimbursement ratio will be different.

If you are hospitalized, you will first deduct 1,000 yuan; if you are hospitalized in a tertiary hospital, you will first deduct 2,000 yuan; then exclude "non-medical insurance drug expenses" and "other non-medical insurance coverage expenses", and the remaining employed personnel will report 80%.

50% are retired or unemployed.

(Note: Medical insurance reimbursement only covers Category A drugs, that is, drugs for medical insurance. Category B drugs are not reimbursable for non-medical insurance purposes.) 2. Inpatient medical reimbursement reimbursement ratio for active employees. Medical insurance hospitalization, the total cost excludes the self-pay part, and after the first 10% of Category B expenses are paid out of pocket,

The portion that exceeds the hospital's medical insurance threshold fee will enjoy a proportion of coordinated payment. Different hospital levels have different threshold fees and a different proportion of coordinated payment.

The proportion of employee medical insurance is more than 80% (Wuhan City 82%/84%/87%), and the proportion of residents’ medical insurance is about 70% (Wuhan City 80%/65%/50%).

3. The social security card does not adjust the proportion of any medical reimbursement. According to the "Beijing Basic Medical Insurance Regulations" promulgated in 2005, the social supplementary medical insurance for retirees under the age of 70 is 50%, and reimbursement procedures are carried out at payment institutions.

At this time, you need to prepare a copy of the medical insurance handbook, medical fee receipts, receipts, details, etc. For details, you can also consult the labor and social security hotline 12333.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China". Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.

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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 settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.