What are the new regulations on medical insurance reimbursement in 2022?
What is the ratio and calculation method for medical insurance reimbursement?
New changes in medical insurance reimbursement in 2022
Outpatient expenses can also be reimbursed
1. Deductible standard
also known as " deductible " threshold fee", which refers to the expenses that insured persons need to pay themselves before enjoying reimbursement of medical expenses. Outpatient deductible is calculated based on an annual cumulative amount, and not every time the deductible is required to exceed the deductible to be reimbursed.
2. Maximum payment limit
is also called the "cap line", which refers to the upper limit of medical insurance fund paying for insured persons within an year. Medical expenses exceeding the limit above the limit will no longer be paid.
3. Payment ratio
also called the "reimbursement ratio", which refers to the reimbursement ratio of medical insurance funds to insured persons below the maximum payment limit above the deductible standard.
1. The payment regulations for the medical expenses of employees incurred in general outpatient (emergency) medical expenses incurred in the following
01. The policy scope of incumbent employees in the city's employee outpatient coordinate is within the policy scope of the designated medical institution in the city. The annual deduction standard for medical insurance funds is 1,000 yuan, and the payment limit is 4,000 yuan. The payment ratio for general outpatients in Community Health Service Center (township health center), municipal (county) and other medical institutions, and provincial medical institutions are 60%, 55%, and 50% respectively; the annual deduction standard for retired personnel is 800 yuan, and the payment limit is 5,000 yuan. The payment ratio of medical institutions at all levels increases by 5 percentage points on the basis of on-the-job employees.
02. The general outpatient expenses incurred by insured personnel during hospitalization, the general outpatient unified fund will not be paid, and will not be included in the cumulative general outpatient expenses. .
03. The medical expenses of general outpatient clinics are not included in the payment scope of serious illness insurance and medical assistance funds.
For example:
If an employee Xiao Zhang went to Hefei municipal medical institution outpatient clinic for medical treatment , spending 3,000 yuan, how much does he reimburse?
first removes the 1,000 yuan deductible line, 2,000 yuan is the base of reimbursement, tertiary hospital reimbursement ratio is 55%, so Xiao Zhang is reimbursed: (3,000-1,000) x 55%=1100 yuan.
Warm reminder
After visiting the hospital, you must remember to bring social security card or medical insurance electronic voucher to the medical insurance settlement window to enter the cumulative amount!
