The first is the raising ratio of medical insurance fund.

The basic medical insurance premium is paid by both the employer and the employee, with the employer paying 7% of the employee's total salary and the employee paying 2% of his salary, which is withheld and remitted by the employer. Retirees don't pay the basic medical insurance premium, and if the employee's contribution salary is lower than 60% of the local average salary of employees in the previous year, it will be paid at 60%. The basic medical insurance fund is composed of the overall fund and the individual account fund, which are accounted for separately and shall not be mutually occupied. 65% of the basic medical insurance premium paid by the employer is included in the overall fund and 35% is included in the personal account.

The second is the proportion of reimbursement for medical expenses of insured employees.

In a medical year (from April 1 day of the current year to March 3 1 day of the following year), the part of the insured who is hospitalized due to illness above the minimum threshold for medical expenses shall be paid by the overall fund in installments, with 75% for the part above the minimum threshold of 5,000 yuan and 80% for the part between 5,000 yuan and 10000 yuan. 16 80% of the daily outpatient medical expenses of patients with overall diseases are paid by the overall fund and 85% by retirees. Among them, the reimbursement rate of outpatient hemodialysis expenses, peritoneal dialysis expenses and taking cyclosporine A after renal transplantation increased by 10%, and the expenses of taking cyclosporine A after renal transplantation were borne by individuals first.

Three, Qifubiaozhun, capping line concept

Qifubiaozhun refers to the amount paid by the basic medical insurance pooling fund for the medical expenses incurred by the insured employees when they are hospitalized. Qifubiaozhun is: the first-class hospital is 8% of the average salary of employees in this city last year (500 yuan); Level II Hospital 10%(600 yuan) and Level III Hospital 12%(700 yuan). The maximum payment limit (capping line) of the overall fund is 4 times (50,000 yuan) of the average salary of local employees in the previous year.

The medical expenses of insured workers exceeding the maximum payment limit shall be solved by the "large medical assistance system". Who participated in the basic medical insurance, according to the standard of 2.5 yuan per person per month, paid in a lump sum in March each year, which shall be borne by the insured individuals. Employees and retirees who did not participate in the local social pooling of old-age insurance were withheld and remitted by their units, and retirees who participated in the local social pooling of old-age insurance were withheld and remitted directly from their pensions by social insurance agencies. The medical year of large medical assistance is consistent with the medical year of basic medical insurance. Large medical expenses fall within the scope stipulated by the state, province and city (drug list, diagnosis and treatment items, scope of medical service facilities and payment standards), and they shall be paid according to 90% of the excess, and the personal burden shall be 10%. In a medical year, the maximum payment limit of large medical assistance fund is10.5 million yuan.

Verb (abbreviation of verb) personal account transfer and management

The basic medical insurance fund consists of medical pooling fund and individual account. 65% of the medical insurance premium paid by the employer (7%) is included in the overall fund, and 35% and 2% paid by individual employees are credited to personal accounts. The formula of personal account transfer is: employee's monthly transfer amount = age coefficient × (my age is-17)+ payment wage coefficient × my monthly payment base+my monthly payment base ×2%, and retiree's monthly transfer amount = age coefficient × (my age is-17)+ pension coefficient × my monthly pension total. This formula embodies the principle of giving priority to efficiency and giving consideration to fairness. The payment salary is high, the age is high, and it is included in personal accounts, which takes care of older workers and retirees to the maximum extent.

Get the medical insurance card next month and you can reimburse it.

The actual reimbursement ratio is related to the payment period.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.