What should I do if the employee medical insurance stops?

Employment groups, such as government agencies, institutions, state-owned enterprises, private enterprises, organizations, etc. All of them are social insurance paid by the employer according to the labor law, which is five of the five insurances and one gold that we usually talk about the most. It consists of medical insurance, maternity insurance, industrial injury insurance, unemployment insurance and endowment insurance. These people's insurance paid by the unit for employees is called employee medical insurance.

Second, residents' medical insurance

In addition to participating in employee medical insurance, the medical insurance paid by oneself is based on the location of household registration. 20 17 according to the unified deployment of the State Council, the national medical insurance system for urban and rural residents has been integrated. That is, the original new rural cooperative medical system and urban residents' medical insurance are integrated, which is called urban and rural residents' medical insurance.

Third, the difference

Lies in the following five aspects:

1 is different in object orientation.

Residents' medical insurance is mainly aimed at unemployed residents, low-income households, students and children;

Employee medical insurance is aimed at working units or flexible employees, individual industrial and commercial households, etc.

2 Different sources of expenses

Individual contributions and financial subsidies for residents' medical insurance; The amount of general financial assistance is much more than that paid by individuals;

Employee medical insurance is jointly paid by units and individuals, with 8% for general units and 2% for individuals;

3 different payment standards.

Residents' medical insurance is paid annually, and there is a collection period. Generally, the annual fee is paid from September to 65438+February. If there is no payment during the collection period, there will be a certain waiting period, that is, you will not be able to enjoy the treatment for a while;

Employees' medical insurance is paid monthly, which is generally stipulated to be paid before the th of each month. There will be a late fee for overdue payment, and medical expenses incurred during the unpaid period will not be reimbursed first, but will be reimbursed after payment.

4 enjoy different treatment.

Residents' medical insurance payment is low, so the treatment is low, and the reimbursement ratio is generally around 45% ~ 65%;

Employees pay medical insurance on a monthly basis with high pay, and the reimbursement ratio is generally around 70% ~ 90%;

note:

(1) Employees will pay part of the money into personal accounts (except for self-employed individuals who have no accounts as a whole). Residents generally do not have personal accounts. Of course, some cities with better conditions will put some money into social security cards to buy medicine, but generally it will only cost tens of dollars.

② Regarding the reimbursement ratio, local policies are different. For the specific ratio, please call 12333 to consult the local community department.

(Example: Take Beijing as an example, specifically look at the reimbursement ratio of medical insurance for employees and medical insurance for urban and rural residents in 20 18 years.

There is a big difference between outpatient reimbursement and hospitalization reimbursement for insured persons in Beijing medical insurance. Generally speaking, the "strength" of outpatient reimbursement is smaller, as shown below. First, the deductible is high, and second, the reimbursement ratio is low.

The deductible line only reimburses medical expenses exceeding this amount, and the outpatient deductible line is cumulative and calculated on an annual basis.

For example, Xiao Li, an employee, went to the hospital twice this year, and the first medical expenses in 800 yuan could not be reimbursed. The second medical expense 1000 has not been reimbursed. Then 20 18, as long as Xiao Li goes to the hospital again, no matter how much it costs, he can be reimbursed in proportion.

In addition, many hospitals in Beijing have regulations that urban and rural residents need to go through referral procedures in the community (or cooperative medical points) before they can go to large hospitals for outpatient treatment, otherwise they will not be reimbursed.

Looking at medical insurance hospitalization reimbursement, the deductible line of employees is lower than that of outpatient reimbursement, but the deductible line of urban and rural residents is higher than that of outpatient reimbursement. However, the reimbursement rate of both employees and urban and rural residents is almost higher than that of outpatient reimbursement. Details are as follows:

The hospitalization deductible line is not accumulated, and the medical expenses for the next hospitalization cannot be reimbursed below the deductible line.

However, according to the regulations of Beijing, except for students and children, other people will be hospitalized for the second time (and later) in the same year, and the deductible standard will be halved, the deductible for employees and retirees will be reduced to 650 yuan, and the deductible for urban and rural residents will also be halved.

Although there are so many differences between employee medical insurance and urban and rural residents' medical insurance, in fact, what needs to be done in the whole process of medical treatment and reimbursement is similar. The deductible and reimbursement ratio will be automatically calculated by hospitals and medical insurance centers, so if we have a strong heart, we can learn more about medical insurance. If we don't understand, it won't have much impact. )

5 different payment requirements

Residents' medical insurance must be paid every year, and if they don't, they won't enjoy the treatment. Without retirement, some cities also require residents to pay fees continuously, otherwise they will not enjoy treatment. If it is interrupted, it may be necessary to pay the fees of previous years (I always think this is not appropriate, only a few cities have this requirement)

What is the difference between the reimbursement ratio of residents' medical insurance and employees' medical insurance?

1, what is the minimum threshold for hospitalization in the local hospitalization year?

Qifubiaozhun refers to the "threshold" that can be paid by the basic medical pooling fund according to regulations. In other words, before the overall fund pays the hospitalization expenses, the individual employees must bear a certain amount of medical expenses before the overall fund begins to pay. According to the regulations of our city, the first Qifubiaozhun in a medical year is 300 yuan, 500 yuan and 700 yuan. Qifubiaozhun for the second hospitalization will be halved, and Qifubiaozhun will no longer be set for the third hospitalization.

2. How is the settlement of medical expenses for local employees calculated?

The maximum payment limit of the basic medical co-ordination fund is 200 thousand yuan. After deducting out-of-scope medical expenses (at one's own expense and partially at one's own expense), the part that is higher than Qifubiaozhun shall be reimbursed in a progressive way. Within 1 10,000 yuan (including 1 10,000 yuan), the personal burden in primary, secondary and tertiary hospitals is 9%, 13% and15% respectively; 10000 yuan to 20000 yuan (including 20000 yuan), the proportion of personal burden in the first, second and third level hospitals is 7%, 9% and11%respectively; 20,000 yuan to 30,000 yuan (including 30,000 yuan), and the personal burden is 7%; 30,000 yuan to the maximum payment limit, personal burden 5%.

3. How is the settlement of medical expenses for local retirees calculated?

The personal burden of retirees is half that of on-the-job workers, and the old workers were half that of retirees before the founding of the People's Republic of China. The deductible line and the maximum payment limit are the same as those of the employees.

Resident medical insurance

Are all medical expenses during hospitalization included in the scope of reimbursement? What is the minimum payment standard?

A: Not all medical expenses during hospitalization are included in the scope of reimbursement. Only medical items that meet the requirements of residents' medical insurance policies are included in the scope of reimbursement. Specifically, only items in the basic medical insurance drug list, diagnosis and treatment items list and medical service facilities list are reimbursed.

The hospitalization Qifubiaozhun is divided into the following situations:

1, local hospitalization Qifubiaozhun. Qifubiaozhun for the first hospitalization in the year is: first-class medical institution (including community health service center) 200 yuan, second-class medical institution 500 yuan, and third-class medical institution 700 yuan; Qifubiaozhun for the second hospitalization was reduced by 100 yuan respectively; The two-time minimum payment standard for township hospitals implementing the national basic drug system is 100 yuan; Private designated medical institutions with undetermined grades shall implement the Qifubiaozhun of secondary medical institutions; Third hospitalization, no deductible.

Within the scope of the policy, the proportion of payment from the Qifubiaozhun to the maximum payment limit of hospitalization medical expenses is 85% and 70% in township hospitals and county hospitals that implement the national basic drug system, 75% in other first-class medical institutions, 65% in second-class medical institutions, 60% in third-class medical institutions, and 60% in private medical institutions with undetermined levels.

(Source: Laiwu Human Resources and Social Security Bureau)

Originally, I paid 80,000 employee pension insurance, and it took two years to get the money. I don't want to enjoy it anymore. Can I get my money back?

The Pension Insurance Department of the Municipal People's Social Security Bureau replied: Generally speaking, employees' pension insurance benefits cannot be withdrawn. Under special circumstances, such as repeated payment, the employee's going abroad to settle down or emigrate or the employee's death before retirement, etc., the old-age insurance can be surrendered with relevant materials.

First-class visual disability, five-guarantee households, the town bought old-age insurance for residents, why not give old-age insurance subsidies when they are old?

The People's Social Security Bureau of Nonggao District replied: The information of Chen Yongzeng's old-age insurance in Yangzhuang Town has been registered and entered by querying the ID card information. However, since the number of recipients of old-age insurance will increase every month, it will be handled in batches. It will take some time to register personal information and bank accounts, but it will be reissued from the month when the benefits are received. Chen Yongzeng's pension insurance will be issued in the near future.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.