The latest Beijing medical insurance specific reimbursement methods. If you participate in social security, you will have up to 3 accounts: a unified fund account (belongs to the public fund, the same for everyone), a large mutual aid account (you decide whether to set it up) and

Personal account (the higher the paid salary is, the higher the personal account balance will be).

Under normal circumstances, payment is borne by both the individual and the unit.

Now let's take a look at the different functions of these three accounts - that is, the payment range of the account.

The first is the overall fund. In general outpatient clinics, the overall fund does not care.

It mainly manages the reimbursement of special outpatient and hospitalization expenses.

Special outpatient reimbursement refers to the reimbursement of treatment costs incurred by radiotherapy and chemotherapy for cancer and dialysis for uremia, excluding surgical costs.

Hospitalization expense reimbursement refers to general hospitalization expense reimbursement and hospitalization expense reimbursement for the first 7 days after the emergency.

Secondly, let’s look at large-scale mutual aid, which is reimbursed for general outpatient services.

As for special outpatient services and hospitalization, large-amount mutual aid reimburses expenses that exceed the reimbursement ceiling of the unified fund within one year (we will discuss the expenses below).

Finally, there is the personal account. As long as there is a balance in the personal account, you can use it freely. In general, you can spend your own money.

Let’s now take a look at the reimbursement regulations for each account.

The overall fund does not provide reimbursement for general outpatient services. The regulations for reimbursement for special outpatient services and hospitalization are: 85%-97% reimbursement, and the minimum payment line is 1,300 yuan.

The annual cumulative fee cap is 70,000 yuan.

Its reimbursement ratio is inversely proportional to the level of the hospital and directly proportional to the amount of medicine prescribed.

The higher the cost, the higher the reimbursement ratio. Taking Beijing's tertiary hospitals (Beijing divides hospitals into 3 levels, with level 3 being the highest) as an example, the medical expenses are 1,300-30,000, and the reimbursement ratio is 85%;

For 30,000-40,000 yuan, the reimbursement rate is 90%; for 40,000 yuan and above, the reimbursement rate is 95%.

For large-amount mutual aid, the minimum payment line for ordinary outpatient clinics is 2,000 (equivalent to the deductible). For payments above 2,000, 50% is quoted, and the maximum claim is 20,000.

Special outpatient and hospitalization reimbursement reimburses 70% of the expenses exceeding the ceiling of the overall pool fund (70,000 yuan), up to 100,000 yuan.

Personal accounts are discretionary.

The monthly income of a personal account is 2% of the personal salary + 0.8%-4.8% of the personal salary from the company. In Beijing, the monthly income of an individual account under the age of 35 is 2.8% of their salary; those between 35 and 44 years old are 3% of their salary.

; 45-retirement is 4% of their salary; retirement-69 is 6.3% of their salary; 79 and above is 6.8%.

Answers to questions related to Beijing’s basic medical insurance 1. The composition of the personal account of basic medical insurance Basic medical insurance premiums paid by individual employees; Basic medical insurance premiums paid by the employer that are transferred to the personal account in accordance with regulations; Interest on the amount stored in the personal account;

Other funds included in personal accounts in accordance with the law.

2. How employers and individuals pay basic medical insurance premiums. Basic medical insurance premiums are paid jointly by employers and individual employees.

The employer pays basic medical insurance premiums based on 9% of the total salary base of all employees.

Employees pay basic medical insurance premiums based on 2% of their average monthly salary in the previous year.

If the employee's average monthly salary is lower than 60% of the city's average monthly salary of employees in the previous year, 60% of the city's average monthly salary of employees in the previous year will be the base wage payment; if it is higher than 300%, 300% will be used as the base payment

.

If the employee's average monthly salary in the previous year cannot be determined, the average monthly salary of the city's employees in the previous year will be used as the base for payment of wages.

Persons who have retired before the implementation of the "Beijing Medical Insurance Regulations" will no longer pay basic medical insurance premiums.

Mutual aid funds for large medical expenses are paid jointly by the employer and the individual.

The employer pays 1% of the total salary base of all employees, and individual employees and retirees pay 3 yuan per month.

Mutual aid funds for large medical expenses are paid together with the monthly basic medical insurance premiums.

3. How the basic medical insurance fund is transferred to the personal account. The basic medical insurance premiums paid by the employer are transferred to the personal account at a certain rate. The standard is: for employees under 35 years old, 0.8% of their monthly payment salary base is transferred to the individual account.

account; for employees over 35 years old and under 45 years old, 1% of their monthly salary base is transferred into their personal accounts; for employees over 45 years old, 2% of their monthly salary base is transferred into their personal accounts; for retirees under 70 years old,

4.3% of the average monthly salary of employees in this city in the previous year will be transferred to personal accounts; for retirees over 70 years old, 4.8% of the average monthly salary of employees in this city in the previous year will be transferred to personal accounts.