The reimbursement limit of medical insurance is as follows:
The reimbursement limit for outpatient medical insurance for urban residents is 2, yuan, and the reimbursement limit for hospitalization is 17, yuan; The upper limit of reimbursement for outpatient medical insurance for urban workers is 2, yuan, and the upper limit of reimbursement for hospitalization is 3, yuan. The maximum reimbursement amount is the accumulated amount paid during the medical insurance year. The payment base and proportion of basic medical insurance premiums have their own provisions. Individual accounts and basic medical insurance pooling funds pay different medical expenses respectively. The cumulative maximum payment limit of medical expenses paid by the basic medical insurance pooling fund for employees and retirees in a year is about 4 times of the average salary of employees in this city in the previous year.
What is the reimbursement limit of medical insurance?
The maximum reimbursement limit of medical insurance for urban residents
Outpatient reimbursement: 2, yuan
Hospitalization reimbursement: 17, yuan
Outpatient reimbursement: 2, yuan
Hospitalization reimbursement: 3, yuan
Supplementary explanation:
1
2. The maximum reimbursement limit of medical insurance for urban workers is 3, yuan, which is 1, yuan for the basic medical insurance pooling fund and 2, yuan for the large mutual funds.
medical insurance base
1. payment base of basic medical insurance
1. employees: the salary base is based on their average salary in the previous month. If the average monthly salary of employees in the previous year is lower than 6% of the average monthly salary of employees in this city in the previous year, 6% of the average monthly salary of employees in this city in the previous year shall be the base of payment of wages, and the basic medical insurance premium shall be paid; The part where the average monthly salary of employees in the previous year was higher than the average monthly salary of employees in this city by more than 3% in the previous year will not be used as the base for payment of wages and will not pay the basic medical insurance premium; If it is impossible to determine the average monthly salary of employees in the previous year, the average monthly salary of employees in this city in the previous year shall be the base of payment salary, and the basic medical insurance premium shall be paid.
2. Employer: the sum of all employees' salary bases is used as the salary base for the unit to pay basic medical insurance.
2. Payment ratio of basic medical insurance premium
1. Employees: Pay basic medical insurance premium according to 2% of their salary base. Transferred to the employee's personal account.
2. Employer: Pay the basic medical insurance premium at 9% of the base salary paid by the employer.
Part of the insurance premium paid by the employer is transferred to the employee's personal account according to the following standards:
(1) Employees under 35 years old are transferred to the personal account according to .8% of their monthly salary base;
(2) Employees over 35 years old but under 45 years old are transferred to individual accounts according to 1% of their monthly salary base;
(3) Employees over the age of 45 are transferred to individual accounts according to 2% of their monthly salary base;
(4) Retirees under the age of 7 shall be transferred into individual accounts according to 4.3% of the average monthly salary of employees in this Municipality in the previous year;
(5) Retirees over the age of 7 shall be credited to individual accounts at 4.8% of the average monthly salary of employees in this Municipality in the previous year.
III. Basic medical insurance benefits
1. Personal accounts pay the following medical expenses:
(1) Medical expenses for outpatient and emergency departments;
(2) the cost of purchasing medicines at designated retail pharmacies;
(3) medical expenses below the minimum threshold of the basic medical insurance pooling fund;
(4) medical expenses that exceed the threshold of the basic medical insurance pooling fund and should be borne by individuals in proportion. The insufficient part of the personal account is paid by myself.
2. The basic medical insurance fund pays the following medical expenses:
(1) Medical expenses for hospitalization;
(2) medical expenses within 7 days before the emergency rescue observation and hospitalization;
(3) outpatient medical expenses of radiotherapy and chemotherapy for malignant tumor, renal dialysis and taking anti-rejection drugs after renal transplantation.
3. the qifubiaozhun paid by the basic medical insurance pooling fund is determined by about 1% of the average salary of employees in this city in the previous year. The qifubiaozhun for the medical expenses incurred by an individual in hospitalization for the second time and later in a year is determined by about 5% of the average wage of employees in this city in the previous year.
4. The cumulative maximum payment limit of medical expenses paid by the basic medical insurance pooling fund to employees and retirees in one year is determined by about 4 times of the average salary of employees in this city in the previous year.
a medical insurance plays a very important role in our life, because each of us will inevitably get sick, and when we get sick, we will need a medical insurance guarantee.
Interpretation of medical insurance reimbursement policy:
According to the relevant policies and regulations of medical insurance, the specific amount of medical insurance reimbursement is determined according to the actual medical expenses of individuals and the provisions of insurance policies. Generally speaking, medical insurance will reimburse medical expenses according to a certain proportion, and the specific proportion may vary according to regions and specific policies. The reimbursement ratio is usually between 5% and 9%, and the specific amount will also be affected by factors such as medical items and drug types.
in order to obtain reimbursement of medical expenses, you need to provide relevant medical invoices, expense lists and other supporting materials, and apply according to the prescribed procedures. In general, you need to pay medical expenses in advance, and then submit an application for reimbursement to the medical insurance institution within the specified time. The medical insurance agency will review your application and will refund the corresponding reimbursement amount to you after it is approved.
It should be noted that different medical insurance policies have different restrictions and regulations on different types of medical expenses. For example, some special treatment items or drugs may not be reimbursed. Therefore, before you enjoy medical insurance reimbursement, it is recommended that you carefully read the relevant insurance contracts and policy terms and understand the specific reimbursement provisions to avoid misunderstanding or disputes.
In a word, the reimbursement amount of medical insurance is determined according to the actual medical expenses of individuals and insurance policies, and the specific amount will be affected by many factors. If you have more questions or need further information, please consult the local medical insurance institutions or professionals.
Legal basis:
Law of the People's Republic of China on Basic Medical Care and Health Promotion
Chapter VII Financial Guarantee
Article 82 The expenses of basic medical services are mainly paid by basic medical insurance funds and individuals. The state raises basic medical insurance funds through various channels according to law, and gradually improves the mechanism for sustainable financing and adjustment of the level of protection of basic medical insurance.
citizens have the right and obligation to participate in basic medical insurance according to law. Employers and employees pay basic medical insurance premiums for employees in accordance with state regulations. Urban and rural residents pay basic medical insurance premiums for urban and rural residents in accordance with regulations.