1, outpatient and emergency medical expenses. During the year, the medical expenses of on-the-job employees who meet the basic medical insurance coverage totaled more than 2,000 yuan;

2. Settlement ratio. During the contract period, 50% of the dispatched personnel will be reimbursed for more than 2,000 yuan, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan;

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate;

4. Outpatient treatment of three special diseases:

(1) When the insured suffers from malignant tumor, chemotherapy, renal dialysis, kidney transplantation and other diseases and needs to take anti-rejection drugs in the outpatient department, the second-and third-level designated hospitals where the insured is located will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing;

(2) Outpatient treatment and drug taking for these three special diseases are limited to designated hospitals approved for treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

5. Hospitalization. After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.

Employee medical insurance outpatient reimbursement process:

1. For outpatient and inpatient treatment, the insured person must show his social security card and swipe his card for medical treatment. The outpatient department must inform the hospital of the treatment category (such as chronic disease and outpatient service). If the card card is not produced or the treatment category is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category (such as outpatient chronic diseases, special), according to the relevant policies to buy drugs, because of special circumstances by others purchasing drugs, must show the insured and the purchaser's identity card, and registered by the pharmacy;

3, outpatient co-ordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can be first diagnosed or referred to community-managed medical institutions in designated community health service institutions for urban workers' basic medical insurance; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs a referral, the first-visit medical institution shall be responsible for the referral, and emergency rescue is not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you can directly enjoy the outpatient co-ordination treatment from the next cost, without referring to the original chronic disease. After the subsidy limit for specific outpatient items is used up, the referral procedures must be handled according to the provisions of outpatient co-ordination, and ordinary medical records can be used to enjoy the outpatient co-ordination treatment, but drugs bought in pharmacies do not enjoy the outpatient co-ordination treatment.

To sum up, the advantage of employee medical insurance is that the protection provided by enterprise employee medical insurance includes normal outpatient and hospitalization expenses. Serious illness assistance needs to be covered by ordinary medical insurance.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.