In this issue, I will show you: the medical insurance treatment standard for in-service and retirees in Henan Province!
First, the basic situation of medical insurance for employees in Henan Province
1. Number of participants
By the end of 2020, the number of employees participating in medical insurance in Henan Province was13.36 million, 540,000 more than that in 20 19, with a growth rate of 4.28%.
2. Income and expenditure of employee medical insurance fund
In 2020, the employee medical insurance fund of Henan Province (including maternity insurance, the same below) earned 52 billion yuan, spent 42.6 billion yuan, and accumulated balance was 75.8 billion yuan. Overall, Henan's income is greater than its expenditure, with a slight balance.
II. Hospitalization medical insurance benefits for employees in Henan Province
Regarding the hospitalization treatment of medical insurance for employees in Henan Province, there are slight differences among the cities under its jurisdiction, and the latest hospitalization treatment of medical insurance for employees in each city shall prevail. Let's take Zhengzhou as an example and make a concrete analysis for reference only.
1. Qifubiaozhun
(1) community health service institutions (including township hospitals): the minimum payment standard is 200 yuan.
(2) Level I medical institutions: the minimum payment standard is 300 yuan.
(3) Secondary medical institutions: Qifubiaozhun is 600 yuan.
(4) Tertiary medical institutions: the minimum payment standard is 900 yuan.
It should be noted that in the same year, the threshold for re-hospitalization will be reduced by 50%.
For example:
Uncle Wang, living in a second-class medical institution for the first time, the minimum threshold is 600 yuan; The minimum payment standard for the second stay in a secondary medical institution is 300 yuan.
2. Proportion of reimbursement
(1) On-the-job personnel: the highest reimbursement rate is 95%, and the lowest reimbursement rate is 88%.
(2) Retirees: The highest reimbursement rate is 97%, and the lowest reimbursement rate is 93%.
It should be noted that the overall reimbursement ratio of medical insurance is related to institutions and personnel categories. The higher the organization category, the lower the reimbursement ratio; The reimbursement rate of retirees is generally higher than that of incumbents.
For example: Uncle Wang, he was admitted to a secondary medical institution due to illness. The total hospitalization expenses are 50,000 yuan, of which 20,000 yuan of medical expenses are beyond the scope of medical insurance reimbursement. So how much did Uncle Wang Can finally reimburse?
Overall reimbursement expenses of Dr. Wang's medical insurance: (50000-20000-600)*95%=27930 yuan.
Write at the end:
Judging from the hospitalization treatment of employees' medical insurance, the cost performance of paying medical insurance fees is still relatively high, especially for retirees, it is very cost-effective to enjoy lifelong medical insurance treatment. However, it should be noted that if you want to enjoy lifelong medical insurance benefits, you need to pay the minimum medical insurance payment period when you retire. For example, the minimum medical insurance payment period in Zhengzhou is: 25 years for men and 20 years for women; And the minimum accumulated payment period is 10 year. Those who retire below the above age limit can choose to pay in one lump sum or on a monthly basis. After one-time payment, you can enjoy the treatment of retirees; Pay on a monthly basis, and enjoy medical insurance benefits only for on-the-job personnel.