The new regulations for employee medical insurance reimbursement in 2023 are as follows:

1. Outpatient reimbursement: the minimum payment line for active employees is 2,000 yuan, and the reimbursement ratio is 50%; retirees under 70 years old, Expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%; for retirees over 70 years old, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 80%.

2. Hospitalization reimbursement: Above the deductible and below the maximum payment limit, active employees pay 85% of Category A and ordinary diagnosis and treatment expenses; retirees pay 90%; Category B drugs pay 75%; high-precision and advanced drugs Pay 70%.

Employee medical insurance outpatient reimbursement process:

1. Insured persons must present their social security card and swipe the card for outpatient and inpatient treatment. The outpatient clinic must inform the hospital of the type of treatment (such as outpatient chronic disease, outpatient outpatient service, etc.) Special), the medical insurance fund will not pay the medical expenses incurred by the insured employees when they seek medical treatment if the card is not presented or the type of medical treatment is unclear;

2. Insured employees purchase at designated retail pharmacies To buy medicines, you must show your citizen card and inform the type of treatment (such as outpatient chronic disease, special care), and purchase medicines by swiping your card according to relevant policies. When someone else purchases medicines due to special circumstances, you must present the ID cards of the insured person and the purchaser, and be informed by Registration and filing of pharmacies;

3. Outpatient coordination implements a first-diagnosis and referral system based on community health service agencies. Insured persons can have their first diagnosis at a community health service institution designated by the Urban Employee Basic Medical Insurance or a medical institution managed by the community; specialized hospitals can serve as the first medical institution for all insured persons. If the insured person needs to be referred, the first medical institution will be responsible for the referral. Emergency treatment and rescue are not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you will directly enjoy the outpatient overall treatment from the next payment. No referral is required for chronic disease treatment at the original chronic disease designated medical center. After the subsidy limit for specific outpatient items is used up, the referral procedures must be completed in accordance with the regulations of outpatient coordination and general medical records must be used to enjoy the benefits of outpatient coordination. Buying medicines in pharmacies does not enjoy the outpatient coordination treatment.

To sum up, the advantage of employee medical insurance is that the protection provided by enterprise employee medical insurance includes normal outpatient and hospitalization expenses. Critical illness assistance requires additional coverage on ordinary medical insurance.

Legal basis:

Article 28 of the "Social Insurance Law of the People's Republic of China"

Comply with the basic medical insurance drug catalog, diagnosis and treatment items, Standards of medical service facilities and medical expenses for emergency and rescue services shall be paid from the basic medical insurance fund in accordance with national regulations.

Article 29

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit . The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.