Basic knowledge of social security

Let me post a picture for you first, from which we can roughly see the current social security structure.

Conceptual framework diagram of social security

Social security classification statement

The concept of social security

The term social security refers to the social security system in a broad sense and the social insurance system in a narrow sense, which is dominated by the state, with all people paying fees and protecting everyone.

Three types of people in social security

Our national social security system first divides the whole society into three categories:

1) On-the-job employees working in the company, such as employees of a company;

2) Freelancers who don't work in the unit, such as writers and writers.

3) Ordinary residents without jobs, such as housewives, students and children.

Six guarantees: social security five guarantees+one gold guarantee (non-social security)

Our country has established corresponding guarantees according to six major events that may happen in an ordinary person's life: birth, old age, illness, work injury, unemployment and house purchase.

1) seeing a doctor-basic medical insurance, commonly known as medical insurance;

2) Pension-basic old-age insurance, commonly known as retirement salary or pension;

3) Maternity-basic maternity insurance, commonly known as paid maternity leave;

4) industrial accidents-basic industrial injury insurance;

5) Unemployment-basic unemployment insurance;

6) buying a house-housing provident fund, commonly known as provident fund loan, is not social security, but the interest rate is low when buying a house with this.

Social security participation

China requires all or part of the above three categories of people to participate in these social security, such as:

1) For employees working in the unit, the state requires that all six guarantees must be attended, which is what many people often say, "five insurances and one gold";

2) Freelancers who don't work in the unit only participate in basic medical insurance and basic old-age insurance, which is not compulsory by the state.

3) Ordinary residents who have no jobs only participate in basic medical insurance and basic old-age insurance, which is not compulsory by the state.

Due to different income levels and different payment pressures, the state divides these guarantees into two grades:

1) The first gear is employee social security, with high payment and high treatment. All the participants are employees and freelancers who can earn money.

2) The second file is social security for residents, with low payment and low treatment. Paid by housewives/men, students and children who can't earn money.

Everyone has read this carefully. I believe everyone should understand the basic system of social security. I suggest you combine the above two pictures for easy understanding. Let me give you a brief explanation of medical insurance in social security, and other guarantees are more detailed. I suggest you go to Zhihu. For example, this article is very detailed:/kloc-Do you need to pay social security after 0/5 years?

Second, the basic medical insurance

All employees' social security participation is "five insurances and one gold", and only two employees' medical insurance and employee pension are the first files. Let's talk about it together.

catalogue

■ What is the use of medical insurance?

Medical insurance has two fixed points and three directories.

medical insurance

Conditions for enjoying medical insurance benefits

■ How to use medical insurance?

Handling and use of medical insurance card

Late medical insurance reimbursement

What are the consequences of lending medical insurance cards?

What's the use of medical insurance?

Medical insurance is used to treat us and buy medicines for reimbursement.

To understand medical insurance, you only need the following picture:

Medical insurance has two fixed points and three directories.

Participating in medical insurance will have a medical insurance card (now basically unified as a social security card), and medical insurance cards can only be reimbursed if they are consumed in designated hospitals and pharmacies. (Designated hospitals and pharmacies are eligible for medical insurance reimbursement)

The scope of reimbursement can only be stipulated in the catalogue of medical insurance drugs, medical insurance diagnosis and treatment and medical insurance service facilities. This is also one of the shortcomings of medical insurance. In order to make up for this defect, we can choose to use commercial medical insurance to supplement it effectively.

Three catalogues of medical insurance

medical insurance

There are medical insurance reimbursement for outpatient and inpatient services, but there are deductible lines and capping lines for medical insurance reimbursement, as well as specific reimbursement scope. Less outpatient and emergency reimbursement, more hospitalization reimbursement; The reimbursement rate of incumbents is low, while that of retirees is high; The reimbursement rate of large hospitals is low, while that of community hospitals is high.

Restrictions on medical insurance

Conditions for enjoying medical insurance benefits

Of course, medical insurance reimbursement costs money. As for how much and how long? This needs to be subject to local regulations, because the payment standards in different regions are different.

After the general medical insurance is paid, it can be reimbursed the next month, but it will take half a year or a year to be reimbursed with a personal account.

If the supply is cut off, the next month after the supply is cut off can't be reimbursed. Generally, the supply is cut off for three months in a row, then the original continuous payment period will be reset and recalculated, which will have a great impact. For details, please call the local social security bureau at telephone number 12333.

Generally, men pay at least 25-30 years before retirement, and women can enjoy medical insurance reimbursement only if they do not pay at least 20-25 years after retirement.

How to use medical insurance?

Social security has "three cards": physical social security card, electronic social security card and electronic medical insurance card. In practice, one of the three can be used for medical insurance reimbursement.

Handling and use of medical insurance card

Company personnel or administrators will generally assist us in handling physical social security cards (also known as financial social security cards, which are actually equivalent to bank cards), or we can handle them personally. I applied from the Agricultural Bank of China, because some banks need half a month to get the physical card, so I need to know this in advance.

You can also find the social security section under the "Citizen Center" on Alipay and get an electronic social security card. After opening, you can brush the QR code in the hospital or pharmacy for reimbursement.

Late medical insurance reimbursement

If you pay social security, but you don't use social security for reimbursement, you can bring relevant information to the social security bureau of the insured place for reimbursement within six months.

Relevant information: ID card, social security card, medical records, various invoice receipts, admission notice, discharge summary, etc.

It is suggested that before going to the Social Security Bureau, it is best to check the phone number of the corresponding institution on the official WeChat account of the National Medical Insurance Bureau to confirm whether the materials are brought in advance, so as to avoid a trip in vain.

Medical insurance reimbursement in different places

As I said before, medical insurance reimbursement can only be reimbursed at designated hospitals and pharmacies in the insured areas. If you go to other cities or other provinces and get sick, this situation belongs to reimbursement in different places.

How to reimburse medical insurance in different places?

Download the "National Medical Insurance Service Platform" APP, and you can make medical insurance reimbursement in different places on your mobile phone. After the record is passed, medical insurance reimbursement can be filed in different places.

However, medical insurance reimbursement in different places needs to pay attention to the following points:

1) medical treatment in different places can only be reimbursed in hospitals that support medical insurance reimbursement in different places. Before you go, you can find the address and phone number on the national medical insurance service platform and the princess of the national medical insurance bureau.

2) When reimbursing medical insurance in different places, how much money can be reimbursed is based on the standard of your insured place (the city where you pay social security), and what items can be reimbursed is based on the standard of your medical place (the city where you are hospitalized).

3) After medical insurance in different places is filed, some places stipulate that social security cards cannot be used locally, some places need to be untied and used, and some places can be used in both places. Here, be sure to call the local social security bureau to confirm.

What are the consequences of lending medical insurance cards?

Lending a medical insurance card to others to see a doctor or buy medicine is a common phenomenon, but it is also an operation with great hidden dangers. Because, after the medical insurance card is lent, other people's medical records will also be recorded in your medical insurance card name, that is, your name, which is very unfavorable to the small partners who need to buy commercial insurance. Here, I suggest that it is best not to borrow a medical insurance card.