New Policy Provisions on Proportion Standard of Employees' Medical Insurance Reimbursement Expenses in Jiangxi Province in 2023

The first is to standardize the proportion of medical insurance reimbursement expenses for employees in Jiangxi Province. If the employee is on-the-job, the medical expenses above 1800 yuan can only be reimbursed after the emergency treatment in the hospital, and the reimbursement rate is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 yuan.

The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.

Second, Jiangxi medical insurance reimbursement process and required materials Jiangxi medical insurance reimbursement materials

1. Outpatient reimbursement information: outpatient invoice, cooperative medical certificate calendar (or medical record).

2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate (or medical record) calendar, detailed list of expenses, discharge summary and other relevant certificates.

3, outpatient special disease reimbursement information: outpatient invoices, special disease cooperative medical certificate calendar.

4. Information for handling special diseases: outpatient treatment proposal for special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and photos.

Jiangxi medical insurance reimbursement process

1, the insured households submit the materials required for reimbursement to the village (community) cooperative medical liaison, and after being audited by the village (community) cooperative medical liaison, they report to the town cooperative medical liaison, who will send them to the district agricultural easy office for reimbursement. Guide to reimbursement of new rural cooperative medical care.

2. Direct reimbursement by the hospital: When going through hospitalization procedures due to illness, you will issue a certificate of the new rural cooperative medical system to the hospital and directly participate in reimbursement.