What are the medical insurance policies for employees with serious illness in Beijing?
Units participating in serious illness medical insurance must strictly follow Beijing's regulations on social pooling of serious illness medical expenses for employees and retirees of local urban enterprises and related documents. This regulation is to ensure that employees and retirees of enterprises can get basic medical insurance when they are seriously ill.
1. Coverage: This provision applies to local enterprises in cities, districts and counties within the administrative area of Beijing (hereinafter referred to as enterprises), their employees and retirees.
Second, the payment standard and payment time:
1, the unit (excluding foreign-invested enterprises) is 6% of the average monthly salary of employees in this city, and the overall medical expenses for serious illness shall be paid monthly according to the number of employees in the unit.
2. Employees shall pay the medical insurance premium for serious illness on a monthly basis at 1% of the average monthly salary of employees in this Municipality in the previous year, which shall be withheld and remitted by the unit;
3. Units participating in medical insurance for serious illness as stipulated in the document of Beijing Labor Insurance [1998] 102 shall pay medical insurance premium for serious illness from 1 July, 998 1 day, and be established after1July, 998/day.
4, foreign-invested enterprises according to the average monthly salary of workers in this city more than 2.5%, according to the number of Chinese employees in the enterprise to pay monthly medical expenses for serious illness. Employees and retirees pay the overall medical expenses for serious illness on a monthly basis, accounting for 1% of the average monthly salary of employees in the city last year.
5. When the average monthly salary of enterprise employees is lower than 10% of the average monthly salary of employees in the whole city, 90% of the average monthly salary of employees in the whole city shall be taken as the base.
6, the unit must pay the full amount of medical insurance premiums for serious illness in the month before the 30th of each month, and shall not interrupt the coverage of medical insurance for serious illness of employees.
Three. Payment standard and reimbursement scope of serious illness pooling fund: the medical expenses incurred by employees in one-time hospitalization due to illness or non-work-related injuries or the accumulated part exceeding 2,000 yuan within 30 days (excluding self-funded part and personal burden part) belong to the payment scope of serious illness pooling fund, and the method of grading calculation and cumulative payment is adopted:
1, more than 2000 yuan and less than 5000 yuan, 90%;
2, more than 5000 yuan 1 ten thousand yuan to pay 85%;
3, 10000 yuan more than 30000 yuan to pay 80%;
4, 30 thousand yuan to 50 thousand yuan to pay 85%;
Pay 90% for 50,000 yuan and above.
Four, one of the following medical expenses does not belong to a serious illness in medical insurance coverage:
1, seeing a doctor in a non-designated hospital without approval (except for emergency rescue);
2. Suffering from occupational diseases, work-related injuries or recurrence of old injuries;
3. Injuries caused by traffic accidents;
4. Injuries caused by my illegal acts;
5. Food poisoning caused by accidents;
6. receiving treatment for suicide;
7. Injuries caused by medical accidents;
8, according to the provisions of the state and the city should take care of medical expenses.
According to the New Deal, the annual maximum payment limit of medical assistance for serious illness of urban workers in Beijing is raised from 20 17 1 in October from 300,000 yuan to 400,000 yuan, and the scope and proportion of medical assistance for serious illness remain unchanged. Medical assistance for serious illness shall be paid at the rate of 90%, and medical insurance for serious illness shall be paid at the rate of 90% if it is transferred to other places for treatment. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: how to use social security medical insurance? 1. Teach you how to apply for reimbursement!
That is to say, if the medical expenses incurred by the insured in a natural year that meet the payment scope of the basic medical insurance exceed the maximum payment limit of 60,000 yuan to 400,000 yuan, 90% will be paid by the aid, and 10% will be paid by the employee who is seriously ill. In addition, the payment amount of medical assistance for serious illness of urban workers remains unchanged.
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