Beijing Medical Insurance Supplementary Medical Care
1. The minimum annual cumulative expenditure for outpatient and emergency services is 2,000 (the 40th Article 1), assuming that your outpatient and emergency expenses are x, then the amount of money reimbursed by medical insurance for you is 0.5*(x-2000). The condition is 2000 2. The "supplementary medical insurance" mentioned in the "Beijing Basic Medical Insurance Regulations" and the "supplementary medical insurance" we call in reality (that is, what your company provides you) are not the same concept at all. . The former should actually be called "Mutual Aid Fund for Large Medical Expenses", which is part of medical insurance. This mutual aid fund is responsible for the reimbursement amounts of two parts. One is the outpatient and emergency expenses mentioned in Article 1 above, ranging from 2,000 to 42,000. The second part is the part after medical insurance reimburses hospitalization expenses exceeding 178,860 yuan (according to Article 32, the average salary in Beijing in 2009 was 44,715 yuan). This part of the money is reimbursed 70%, and the maximum can give you 100,000 yuan. The latter is commercial insurance, bought from companies such as Ping An Insurance Company, in order to supplement the non-reimbursement provisions of the "Beijing Basic Medical Insurance Regulations". That is, x<2000 or x>42000. Depending on the regulations of the insurance company, some commercial insurance also covers the portion of 2,000 In general, because social security has limits on deductibles, reimbursement ratios, upper limits, restrictions on designated hospitals, some restrictions on self-paid medicine and treatment fees, and restrictions on exemptions (such as crimes, Self-mutilation, traffic accidents, etc.), therefore commercial supplementary medical insurance is needed, and the state has preferential policies for companies to purchase supplementary medical insurance, so it is not a big burden for companies to provide supplementary medical insurance to their employees. Beijing Basic Medical Insurance Regulations (Announced by Order No. 68 of the Beijing Municipal People’s Government on February 20, 2001) According to Beijing’s December 1, 2003 First revision of Beijing Municipal People's Government Order No. 141 Second revision according to Beijing Municipal People's Government Order No. 158 on June 6, 2005) Contents Chapter 1 General Provisions Chapter 2 Basic Medical Insurance Fund Chapter 3 Basic Medical Insurance Personal Account Chapter 4 Basic Medical Insurance Benefits Chapter 5 Supplementary Medical Insurance Chapter 6 Medical Management Chapter 7 Organizational Management and Supervision Chapter 8 Legal Responsibilities< /p> Chapter 9 Supplementary Provisions Chapter 1 General Provisions Article 1 In order to ensure that employees and retirees receive basic medical care and enjoy medical insurance benefits when they are sick, according to These regulations are formulated in accordance with relevant national regulations and in light of the actual situation of this city. Article 2 All urban employers within the administrative region of this city, including enterprises, agencies, institutions, social groups, private non-enterprise units (hereinafter referred to as employers) and their employees and retirees, shall apply to this Article. Regulation. The specific time for employers and their employees and retirees to participate in basic medical insurance shall be stipulated by the municipal labor and social security administrative department (hereinafter referred to as the municipal labor and social security administrative department). Article 3 The municipal labor and social security administrative department shall be in charge of the city’s medical insurance work, organize the implementation of the medical insurance system, and be responsible for the management, supervision and inspection of medical insurance work. The district and county labor and social security administrative departments are responsible for the management, supervision and inspection of medical insurance within their respective administrative regions. The social insurance agency established by the municipal and district and county labor and security administrative departments specifically handles medical insurance work. Article 4 Basic medical insurance premiums shall be borne by both the employer and individual employees, paid simultaneously by the employer, and coordinated by the city as a whole. The basic medical insurance fund implements the principle of combining social pooling and personal accounts. The protection level of basic medical insurance should be compatible with the development level of social productivity in this city and the affordability of finance, employers and individuals. Article 5: On the basis of implementing basic medical insurance, this city will establish a mutual aid system for large medical expenses and implement the national medical subsidy measures for civil servants. Enterprises and institutions can establish supplementary medical insurance, and encourage employers and Individuals participate in commercial medical insurance. Article 6: Combined with the establishment of the basic medical insurance system, actively promote the reform of the urban medical and health system, provide employees and retirees with relatively high-quality medical services at relatively low costs, and meet the basic medical needs of the broad masses of the people. service needs. Chapter 2 Basic Medical Insurance Fund Article 7 The basic medical insurance fund shall be based on revenue and expenditure shall be balanced.