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Address: No. 3,East Yongding Road, Haidian District, Beijing (No. 15 Yongding Road, Haidian District)

Mail box: zxyjh@zxyjh.com.cn

Hospital Tel: 010-88223585

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Answers to questions related to basic medical insurance 1. Composition of basic medical insurance personal accounts

n Basic medical insurance premiums paid by individual employees;

n Basic medical insurance premiums paid by employers assigned to individual accounts in accordance with regulations;

n interest on personal account storage;

n Other funds that are legally included in the personal account.

2. How employers and individuals pay basic medical insurance premiums

The basic medical insurance premium is paid by the employer and the individual employee.

The employer pays the basic medical insurance premium at the sum of 9% of the total wages of all employees. Employees pay basic medical insurance premiums at 2% of their average monthly salary. The monthly average salary of the employees is lower than the average monthly salary of the employees of the city in the previous year. 60% of the average monthly salary of the employees in the city in the previous year is the base of the payment wage; if the higher than 300% is based on 300%, the payment is based on 300%. . If it is impossible to determine the average salary of the employee in the previous year, the average monthly salary of the employee in the city in the previous year is the base of the payment wage. Those who have retired before the implementation of the Beijing Municipal Medical Insurance Regulations will no longer pay basic medical insurance premiums.

Mutual assistance for large medical expenses is paid jointly by employers and individuals. The employer pays 1% of the sum of the total wages of all employees, and the employees and retirees pay 3 yuan per month. The large amount of medical expenses mutual aid funds are paid together when the basic medical insurance premium is paid monthly.

3. How is the basic medical insurance fund classified into personal accounts?

The basic medical insurance premium paid by the employer is allocated to the individual account in a certain proportion. The standard is:

Employees under the age of 35 are placed in their personal accounts at 0.8% of their monthly salary base;

Employees under 35 years of age and under 45 years of age are classified into personal accounts at 1% of their monthly salary base;

Employees over the age of 45 are placed in their personal accounts at 2% of their monthly salary base;

Retirees under the age of 70 are classified into personal accounts according to 4.3% of the average monthly salary of the city's employees in the previous year;

Retirees over the age of 70 are classified into personal accounts based on 4.8% of the average monthly salary of the city's employees in the previous year.

◆ Basic medical insurance contribution rate and individual account transfer diagram

Unit payment personal contribution is credited to personal account

9%+1%2%+3 yuan under the age of 35%

35-45 years old 1%

Over 45 years old 2%

Retirement 3 yuan per person per month, under the age of 70, 4.3%

Over 70 years old 4.8%

Fourth, outpatient, emergency medical treatment instructions

◆ Medical advice

1. Insured personnel must take the Beijing Social Security Card and the “Handbook for Emergency Medical Records of Medical Institutions in Beijing” (hereinafter referred to as the Social Security Card and the Outpatient Medical Record) for medical treatment, and present them as required;

2. The new insured person does not issue the social security card, and the social security card is lost during the period of re-issuance. He holds the “New and Supplementary (Replacement) Social Security Card Certificate” (ie “temporary medical card”) and seeks medical advice as required;

3, can go to the designated hospital for medical treatment, or go to Beijing designated hospital, designated Chinese medicine hospital, Class A hospital (note: once a year) for medical treatment;

4, due to emergency can not go to the above-mentioned designated medical institutions for medical treatment, can go to the nearest medical insurance designated medical institutions for emergency treatment, should be timely transferred back to my designated medical institutions after the condition is stable;

5. When purchasing medicines at designated pharmacies in medical insurance, it is necessary to hold medical insurance prescriptions issued by medical institutions designated by the medical institutions, and to stipulate the “Special Seal for Foreign Basic Medical Insurance Prescriptions in Beijing”.

6. Insured personnel social security card or "medical insurance manual" lost, in-service retired, insurance conversion (urban residents transfer to urban workers), etc., must hold social security card and "medical insurance manual" to the social security center for information synchronization.

7. The insured person needs to take the same kind of medicine for a long time if he is in stable condition. However, due to mental illness or inconvenience, long-term bed rest, etc., he/she cannot go to the designated hospital for medical treatment. The family member of the insured person can hold the valid ID of the patient (ID card and Social security card), the outpatient medical record manual of the confirmed hospital or the certificate of discharge diagnosis, to the designated hospital to open the drug.

◆ Reimbursement standard

1. Incumbents

In an annual outpatient and emergency medical expenses totaling more than 1,800 yuan, the large amount of medical expenses mutual aid funds will be paid 70%, and the outpatient and emergency medical expenses will be paid up to 20,000 yuan a year.

2. Retirees

An annual outpatient and emergency medical expenses totaling more than 1,300 yuan, retirees under the age of 70, 85% of the large medical expenses mutual aid funds, retirees over 70 years old, 90% of the large medical expenses mutual aid funds, outpatient service The emergency medical treatment costs up to 20,000 yuan per year.

3, in the fixed-point hospital emergency rescue to pay attention to the medical expenses of the unreceived hospital, belonging to the door, emergency costs, according to the general outpatient service.

V. Hospitalization for medical treatment

(1) Medical treatment instructions

1. You must take the real-name system of the Beijing Social Security Card (or the “New and Supplementary (Replacement) Social Security Card Certificate) (hereinafter collectively referred to as the Social Security Card);

2. During the period when the insured person has not issued the social security card and the social security card has been lost due to the new insured, he will seek medical treatment with the “New and Supplementary (Replacement) Social Security Card Certificate”;

3, can go to the designated hospital for medical treatment, or go to Beijing designated hospital, designated Chinese medicine hospital, Class A hospital (note: once a year) for medical treatment;

4. When the emergency can not go to the designated medical institution selected by me, you can go to the nearest designated medical institution for emergency treatment. After the condition is stable, you should transfer it back to your designated medical institution in time;

5, card or manual to the inpatient department to go through the hospitalization procedures, at the same time pay a certain amount of advance payment according to hospital regulations (for payment of deductible lines, self-pay and self-pay);

6. During the hospitalization period, if you use drugs, medical treatment projects and service facilities that you should pay at your own expense or at your own expense, you must sign a “self-pay agreement” with the hospital to prevent disputes arising from self-funded projects;

7. If the insured person needs to be transferred to the hospital for treatment due to illness, he/she must be approved by the hospital medical insurance office and use the social security card for examination and approval procedures. Transfers within 24 hours are treated as consecutive hospitalizations, and the medical expenses incurred after hospitalization and the medical expenses incurred before hospitalization are calculated cumulatively;

8, discharge medicine: in principle, no more than 7 days, the inconvenience of movement can be opened for two weeks.

(2) Reimbursement standards

1. The threshold for the first hospitalization in a year is 1,300 yuan, and the threshold for the second and subsequent hospitalizations is 650 yuan;

2. The medical expenses paid by the basic medical insurance pooling fund, the maximum payment limit for one year is 100,000, and the maximum payment limit for large mutual aid funds is 200,000 yuan. See the chart for specific reimbursement methods.

3. The medical expenses incurred after reimbursement of more than 100,000 in-patient reimbursement in the year, the in-service personnel shall pay 85% of the large-amount medical expenses mutual aid funds, the individual pays 15%, and the retirees pay 90% (including the retirees unified supplementary insurance), personal payment 10%.

4. Accumulated settlement of medical expenses and hospitalization expenses on the 7th day before the hospital in the emergency department of the designated hospital;

5. The hospitalization settlement period for common diseases is 90 days. The next deductible line for more than 90 days is regarded as the second hospitalization.

 

 

Basic medical insurance pooling fund reimbursement chart

Table 1: Retirement chart for active employees

 hospital

Payment segment ratio

Primary hospital

Secondary hospital

Tertiary hospital

Coordinated payment

Personal payment

Coordinated payment

Personal payment

Coordinated payment

Personal payment

Starting standard -30,000

90%

10%

87%

13%

85%

15%

More than 30,000 to 40,000 yuan

95%

5%

92%

8%

90%

10%

More than 40,000 - pay 100,000 yuan

97%

3%

97%

3%

95%

5%

 100,000 yuan - 300,000 yuan

The personal burden of the incumbent is 15%

Table 2: Retirement Reimbursement Chart

hospital

Payment segment ratio

Primary hospital

Secondary hospital

Tertiary hospital

Coordinated payment

Personal payment

Coordinated payment

Personal payment

Coordinated payment

Personal payment

Starting standard -30,000

94%

6%

92.2%

7.8%

91%

9%

More than 30,000 to 40,000 yuan

97%

3%

95.2%

4.8%

94%

6%

More than 40,000 - pay 100,000

98.2%

1.8%

98.2%

1.8%

97%

3%

100,000 yuan - 300,000 yuan

Retirees personal burden 10%