Differences between Grade One and Grade Two between Urban and Rural Residents

The differences between urban and rural residents in the first and second stalls are as follows:

1, the payment ratio is different. The proportion of primary medical insurance payment is 8.2%, the unit payment is 6.2%, and the individual payment is 2%. The secondary payment ratio of medical insurance is 0.8%, the unit pays 0.6%, and the individual pays 0.2%. The payment base is the average monthly salary of employees in the previous year, with a total payment of 59.8 yuan;

2, the applicable population is different. The first file of medical insurance: generally purchased by well-known large companies and listed companies; Second-class medical insurance: general companies pay second-class medical insurance;

3. The principle of seeking medical treatment is different. First-class insured: any designated medical institution in this city for medical treatment; The second-level insured person goes to the binding social health center for medical treatment, is hospitalized in any designated medical institution in the city, and is seriously ill and goes to the prescribed medical institution for medical treatment;

4. Hospitalization reimbursement is different. Grade I: 90% of the hospitalization report, requiring hospitalization in a designated hospital; The second file: the hospitalization report is 90%, and hospitalization needs to be handled in a designated hospital;

5. Outpatient reimbursement is different. The first file: continuous insurance 12 months, and 70% can be reimbursed if the annual self-expense exceeds RMB 3 1, 3 1; Social health report 30%; Large equipment inspection report 80%; Grade II: There is an annual outpatient fee of 1 1,000 yuan, which needs to be bound to a community health hospital. Maximum amount of outpatient large-scale equipment inspection and treatment1.20;

6. The time requirements for registration are different. The first-level insured person has been insured continuously for one year, and the average salary of supermarket employees is 5% of the basic outpatient medical expenses and supplementary medical expenses paid by himself in the same medical insurance year. The 70% of the excess is paid by the overall fund according to the regulations, and the second-level insured person has no specific time requirements.

legal ground

People's Republic of China (PRC) social insurance law

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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. Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.