Can you still be reimbursed for hospitalization if your health insurance has stopped paying?

Social security has stopped paying, hospitalization is not reimbursed. After the social security payment is interrupted, the medical insurance is also the state of interruption, this time, if you are sick and hospitalized, you can not enjoy the medical insurance reimbursement. In particular, interruption of employee medical insurance will not only affect the hospitalization reimbursement, but may also cause you to fall short of the accumulated years requirement, and you will not be able to enjoy the health insurance benefits as scheduled. Employee health insurance has a 3-month buffer period from the date of discontinuation, and if you renew it as soon as possible during this period, then you may still be able to get reimbursed if you are hospitalized. However, if this period is exceeded, then you may need to contribute for a certain period of time again before you can enjoy hospitalization reimbursement. Individuals who have participated in the basic medical insurance for employees, and who have contributed for a total of the required number of years (e.g., 25 years for men and 20 years for women in Xiamen) by the time they reach the legal retirement age, will no longer be required to pay the basic medical insurance premiums after retirement, and will be entitled to the basic medical insurance benefits in accordance with the state regulations; and those who have not yet reached the required number of years will be able to pay the premiums for as long as the required number of years.

The basic medical insurance fund shall not pay for the following medical expenses: medical treatment at a medical institution other than the designated medical institution of the person himself, except for emergencies; purchase of medicines at a retail pharmacy other than the designated pharmacy; and injuries caused by traffic accidents, medical malpractice, or other accidents of responsibility. Injuries caused by one's own drug use, fighting or other illegal acts; treatment for suicide, self-injury, alcoholism, etc.; treatment abroad or in Hong Kong, Macao Special Administrative Region and Taiwan; and those that should be paid for by the individual in accordance with the provisions of the state and the city.

If a participant who has continuously participated in basic medical insurance for more than one year is interrupted for less than three months in a medical insurance year due to a change of job, the years of continuous participation before and after the interruption can be calculated together after the re-payment of premiums and enjoy the benefits of basic medical insurance; if the interruption of participation is more than three months, the years of participation will be recalculated again in the medical insurance year. Those who have paid basic medical insurance premiums for 25 years for men and 20 years for women after retirement, and who have gone through the retirement procedures in accordance with the state regulations and are receiving basic pension or retirement fees on a monthly basis, are entitled to the basic medical insurance treatment for retirees and no longer pay basic medical insurance premiums. The individual account pays for the following medical expenses: outpatient and emergency medical expenses; expenses for medicines purchased at designated retail pharmacies; medical expenses below the starting standard of the basic medical insurance coordinating fund; and medical expenses exceeding the starting standard of the basic medical insurance coordinating fund, which should be borne by the individual according to the proportion. The portion of medical expenses not covered by the individual account shall be paid by the individual himself/herself.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 2: The State establishes a system of social insurance for basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., and guarantees the right to receive material assistance from the State and society according to the law for the citizens in the event of old age, sickness, industrial injury, unemployment and maternity. and society in the event of old age, sickness, industrial injury, unemployment or maternity, in accordance with the law.

Article 4 Employing units and individuals within the territory of the People's Republic of China shall, in accordance with the law, pay social insurance premiums, and shall have the right to enquire about the records of payment of premiums and the rights and interests of individuals, as well as to demand that the social insurance administration organizations provide social insurance advice and other relevant services. Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise the payment of contributions on their behalf by their own units.

Article 58 An employer shall, within thirty days from the date of employment, apply for social insurance registration with a social insurance agency for its employees. If the employer fails to apply for social insurance registration, the social insurance agency shall approve the social insurance contributions to be paid by the employer. Individual entrepreneurs without employees who voluntarily participate in social insurance, part-time workers who do not participate in social insurance with their employers, and other flexibly employed persons shall apply for social insurance registration with the social insurance administration organization. The State establishes a nationally unified individual social security number. Individual social security numbers are citizens' identity numbers.