Part of the answer is also my interpretation of the subsequent policy (I couldn’t find any information about real-time reimbursement under the new regulations, and I don’t know clearly) 1. The minimum payment threshold for outpatient and emergency expenses for a year is 2,000 (Article 40-1). Assume your
The cost of outpatient and emergency care is x, then the amount of money reimbursed by medical insurance for you is 0.5*(x-2000).
The condition is 2000 That is, the upper limit is NT$42,000. 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 of 2,000 to 42,000 mentioned in Article 1 above, and the other is hospitalization expenses. After medical insurance reimburses more than 178,860 yuan (according to Article 32, the average salary in Beijing in 2009 was 44,715 yuan), 70% of this part will be reimbursed, up to 100,000 yuan. The latter is commercial insurance, purchased 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 The specifics will depend on the details of the commercial insurance your company chooses. In general, because social security has limits on deductibles, reimbursement ratios, upper limits, restrictions on designated hospitals, some restrictions on self-paid medicines and treatment fees, and restrictions on exemptions (such as crime, 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. It is not a big burden for companies to provide supplementary medical insurance to their employees. Beijing Basic Medical Insurance Regulations (promulgated by Beijing Municipal People’s Government Order No. 68 on February 20, 2001, first revised according to Beijing Municipal People’s Government Order No. 141 on December 1, 2003, and June 6, 2005). Second Revision of Order No. 158) Table of 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 Organization Management and Supervision Chapter 8 Legal Responsibilities 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, this document is formulated in accordance with relevant national regulations and in light of the actual situation of this city. Regulation. Article 2 These regulations shall apply to 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. 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. District and county labor and security administrative departments are responsible for the management, supervision and inspection of medical insurance within their respective administrative regions. Social insurance agencies established by municipal and district and county labor and security administrative departments specifically handle medical insurance work. Article 4 Basic medical insurance premiums shall be borne by both the employer and individual employees, paid jointly 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 basic medical insurance, this city has established a mutual aid system for large medical expenses and implemented the national medical subsidy measures for civil servants. Enterprises and institutions can establish supplementary medical insurance and encourage employers and individuals to participate in commercial medical insurance. Article 6 In conjunction 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 service needs of the broad masses of the people. Chapter 2 Basic Medical Insurance Fund Article 7 The basic medical insurance fund shall be based on revenue and shall balance revenue and expenditure.