The maximum payment limit for employees is increased to 300,000 yuan: for the hospitalization medical expenses of those participating in the basic medical insurance for employees, the maximum payment limit for medical insurance in one year is adjusted from 170,000 yuan to 300,000 yuan, of which: the maximum payment limit for the basic medical insurance pooling fund is adjusted to 10
0,000; the maximum payment limit for large-amount medical mutual aid funds is adjusted to 200,000.
The reimbursement for large hospital medical expenses for employees will be increased to 85%, and the reimbursement ratio for hospitalization medical expenses exceeding the maximum payment limit of the basic medical insurance pooling fund will be increased.
Among them, the reimbursement ratio for active employees was adjusted from 70% to 85%, and the reimbursement ratio for retirees was adjusted from 85% to 90% (including supplementary medical insurance for retirees).
The adjustment of the reimbursement ratio will improve the level of personal medical treatment, especially the large-amount medical treatment of active employees will increase by about 20%.
Legal basis: Article 2 of the "Social Insurance Law of the People's Republic of China" The state establishes basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurance systems to protect citizens in the event of old age, illness, work-related injury,
The right to obtain material assistance from the state and society in accordance with the law in cases of unemployment, childbirth, etc.
Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical insurance and basic medical insurance for urban residents shall be implemented in accordance with national regulations.
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 paid from the basic medical insurance fund in accordance with national regulations.
China fund newspaper Wu Lu
On June 5438+1October 65438+March 2023, official website, the CSRC, issued the Reply on Agreeing to Establ