New rules for medical insurance reimbursement in 2022

The new policy of medical insurance reimbursement standard in 2022 can be divided into the following three parts:

1, outpatient reimbursement. If the hospital sees a doctor with minor ailments and pains, it will usually generate more outpatient expenses. Then the employee medical insurance can directly deduct the outpatient expenses from the personal account balance. If the outpatient expenses of the resident medical insurance exceed 200 yuan this year, it can be reimbursed according to the proportion of 50%, and the maximum payment limit is 400 yuan;

2, hospitalization reimbursement. There are new changes in the ups and downs of hospitalization this year, which are defined as a primary doctor in 200 yuan, a secondary hospital in 400 yuan and a tertiary hospital in 800 yuan. If the hospitalization expenses of the insured are above the deductible line, the reimbursement rate of employees' medical insurance can be divided into 88%, 85% and 82% according to the level of these hospitals, while the reimbursement rate of residents' medical insurance is 80%, 70% and 60% respectively, and the deductible line standard for more than two hospitalizations in the same natural year is 50% of the first deductible line standard.

3. Reimbursement conditions. The standard reimbursement conditions specified this year do not include the following five medical expenses:

(1) Seek medical treatment abroad, Hong Kong, Macao and Taiwan;

(2) Suicide or self-mutilation (except mental illness);

(3) Accidents such as traffic, accidental injury and medical treatment are borne by other parties;

(4) Being injured or sick due to his own illegal and criminal acts;

(5) Other expenses that are not paid by medical insurance regulations, such as cosmetic surgery, weight loss, infertility, sexual dysfunction, etc.

Legal basis: Article 26 of People's Republic of China (PRC) Social Insurance Law.

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.