The proportion of medical insurance reimbursement for employees refers to the proportion of medical expenses shared by social pooling funds and insured employees. Taking China as an example, employee medical insurance is mainly divided into two types: basic medical insurance for urban employees and supplementary medical insurance for enterprise employees. In the basic medical insurance for urban workers, according to different regions and different types of medical insurance systems, the reimbursement ratio is also different. For example, in Beijing, the reimbursement rates for employee medical insurance, outpatient special diseases, outpatient chronic disease treatment and hospitalization are 60%, 50% and 80% respectively, and the part that is higher than the coverage of basic medical insurance is paid by the insured. In Nanjing, Jiangsu Province, the reimbursement rates of outpatient special diseases, outpatient chronic disease treatment and hospitalization basic medical insurance are 60%, 40% and 90% respectively. In addition, when the expenses are beyond the scope of overall payment, employee medical insurance also has relevant policies to stipulate the upper limit of individual payment to reduce the burden on the insured.
What is the social pooling fund? Social pooling fund refers to the public fund set up by the government to pay medical expenses, which is mainly paid by the government, enterprises and individuals. According to different systems, the payment ratio is also different. The purpose of social pooling fund is to improve people's medical security level and relieve the pressure of medical expenses.
The proportion of medical insurance reimbursement for employees is the proportion of medical expenses borne by social pooling funds and insured employees. The reimbursement ratio of different regions and different types of medical insurance is also different. As an important social security system, employee medical insurance aims to improve people's medical security level and ease the pressure of medical expenses.
Legal basis:
Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.