The specific reimbursement scope of the medical mutual aid fund is as follows: 1. Outpatient medical expenses: Within the payment range of the basic medical insurance (referring to the maximum payment amount from the minimum payment line to the cap line), the "self-pay" part of the expenses borne by the employee will be deducted 1,800
After the minimum payment line, the mutual aid fund is calculated at a rate of 20% (25% for model workers and extremely poor workers); 2. Hospitalization medical expenses: within the payment range of the basic medical insurance (referring to the maximum payment amount from the minimum payment line to the cap line), from
For the "self-pay" expenses borne by employees, 1,300 yuan will be deducted for the first hospitalization (650 yuan will be deducted for the second hospitalization including two or more hospitalizations; for extremely poor employees, 650 yuan will be deducted for the first hospitalization, and 325 yuan will be deducted for the second hospitalization including two or more hospitalizations).
After paying the line, the mutual aid fund will be calculated at a rate of 20% (25% for model workers and extremely poor employees); 3. Outpatient and inpatient medical expenses above the cap line: Employees’ outpatient and inpatient “self-pay” expenses reach the cap line of basic medical insurance
Afterwards, if you still have to pay out-of-pocket expenses within the scope of medical insurance, you can enjoy 40% of the mutual aid from above the cap line to within 50,000 yuan, and the maximum reimbursement amount is 20,000 yuan; for the part from 50,000 yuan to 100,000 yuan, you can enjoy 60% of the mutual aid
The maximum reimbursement amount is 30,000 yuan; for the amount above 100,000 to 150,000 yuan, 80% of the mutual aid fund can be enjoyed, and the maximum reimbursement amount is 40,000 yuan.
The specific steps for reimbursement of employee medical mutual aid funds are as follows: 1. Log in to the mutual aid association website, which requires the account number and password. Generally, the person in charge of the unit's labor union knows this; 2. After entering, find the application business and click to enter; 3. Click to initiate a new
When applying, fields such as entering the ID number will appear. Just enter the applicant's information.
And select the type of insurance that your unit participates in. You can apply for this twice, because you can only apply for one category at a time.
If you participate in critical illness and hospitalization insurance, you can apply for hospitalization allowance first, and then apply for hospitalization + critical illness.
In this way, you can get two compensations; 4. After the selection is completed, enter the main information filling area and upload the ID card photo, hospitalization invoice photo, and bank card photo prepared in advance.
It should be noted that the specific amount in the invoice needs to be entered one by one; 5. After submission, wait for system review. It usually takes 3 working days to pass the review, and the money will be directly transferred to the user's bank card account.
To sum up, before applying for medical mutual aid insurance reimbursement, you must first understand the reimbursement policy of the medical mutual aid plan you participate in, including reimbursement scope, reimbursement ratio, deductible, etc.
This will help you understand more accurately how much you can be reimbursed and how much you will need to pay out-of-pocket.
Legal basis: "Social Insurance Law of the People's Republic of China" Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be deducted from the basic medical insurance fund in accordance with national regulations.
Pay.