According to the principles of the state on the reform of employee medical insurance system and the relevant regulations of Beijing, our company participated in the overall planning of medical expenses for employees with serious illness (hereinafter referred to as overall planning), to ensure that employees and retirees of our company get basic medical insurance when they are seriously ill, and to balance the burden of medical expenses of enterprises.
The principles of serious illness co-ordination are: mutual assistance, at your own risk; Guarantee basic medical care and overcome waste; The state, enterprises and individuals should bear the burden reasonably.
The specific related matters of serious illness co-ordination are briefly introduced as follows:
One.
Coordinate the implementation of the fund system.
Districts and counties set up overall funds, and the whole city set up overall adjustment funds. In accordance with the principle of "fixed income by expenditure, slight balance, and certain reserves", it is raised to be earmarked for serious illness medical expenses.
Two.
Overall scope:
The medical expenses incurred by employees and retirees in one-time hospitalization due to illness or non-work-related injuries or the accumulated medical expenses within 30 days exceed 2,000 yuan, which belongs to the scope of overall planning.
However, the medical expenses under any of the following circumstances do not belong to the scope of overall planning:
1.
Going to 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 liability accidents;
6.
Treatment for suicide (except psychotic episode);
7.
Injuries caused by medical accidents;
8.
According to the national and municipal regulations, medical expenses should be taken care of by themselves.
Three.
Payment of the overall fund:
Payment standards and fees:
1. 6% of the average monthly salary of employees in cities above enterprise level, and the overall medical expenses for serious illness shall be paid monthly according to the number of employees in enterprises.
2. According to 2.5% of the average monthly salary of employees of foreign-invested enterprises in the city last year, pay the overall medical expenses for serious illness on a monthly basis according to the number of Chinese employees in the enterprise.
3. Employees and retirees pay the overall medical expenses for serious illness on a monthly basis, which is 1% of the average monthly salary of employees in the city in the previous year, and the enterprise will withhold and remit it from the wages of employees and retirees.
Note: The part that the above-mentioned employees should pay personally is now borne by the company for the employees who participate in the overall planning, and it is regarded as the additional welfare of the employees, and has not been deducted from the salary.
Four.
Medical management:
The designated hospital system is implemented for serious illness medical treatment. Workers and retirees go to designated hospitals for medical treatment with medical insurance cards. If it is really necessary to be transferred for treatment, it shall go through the examination and approval procedures for transfer.
Employees and retirees who really need to do special inspection, special treatment or use expensive drugs shall go through the relevant examination and approval procedures, and the employees and retirees shall bear part of the expenses.
Five.
Fund payment:
As a whole, the fund pays for medical expenses by grading calculation and cumulative payment. The specific standards for medical expenses of more than 2,000 yuan are as follows:
1.
The part between 2000 yuan and 5000 yuan is 90%;
2.
5000 yuan to 10000 yuan to pay 85%;
3.
10000 yuan to 30000 yuan to pay 80%;
4.
The part between 30,000 yuan and 50,000 yuan is 85%;
5.
More than 50,000 yuan will be paid 90%.
The "above" mentioned in the preceding paragraph does not include this number, and "below" includes this number.
Six.
Serious illness medical expenses reimbursement:
Enterprises fill in the Approval Form for Appropriation of Social Pooling Fund for Serious Illness Medical Expenses, and report it to the district and county social insurance fund management institutions for review and appropriation.
The remaining part of the medical expenses paid by the overall fund shall be shared by enterprises and individuals. The burden on enterprises shall not be less than 70%.