How to pay for medical insurance for employees in Taiyuan in 2002?

Questions and Answers on Medical Insurance Policy for Flexible Employment in Taiyuan City

(Number of hits: 1 164 Date of publication: 2005- 1 1-09)

First, the scope of flexible employment

Scope of flexible employees: owners and employees of urban individual economic organizations (including individual industrial and commercial households) who have reached the legal employment age and have the ability to work in six districts of this city, freelancers and flexible forms of employment such as part-time, temporary and flexible work. Age requirements: 18 years old, male under 60 years old, female under 55 years old; 16- 18 age group, those who mainly rely on their own labor income are also within the scope. Identity requirements: non-retired, retired personnel.

Second, the payment standard for flexible employees

Flexible employees participate in basic medical insurance, and the payment base is approved according to the average annual salary of employees in Taiyuan last year, and the payment ratio is 8.5%. The basic medical insurance premium paid by employees of individual economic organizations shall be shared by the owners and employees according to the ratio of 6.5% and 2%.

Flexible employees to participate in serious illness medical insurance, the monthly standard for 5 yuan, borne by individuals. Flexible employees pay basic medical insurance premiums and serious illness medical insurance premiums annually. From this month 16 to the next month 15, you can pay the medical insurance premium from the next month to the next month at the designated bank according to the payment notice filled out by the intermediary agency. For example, on June/KOOC-0/0, 2004, he registered for medical insurance, and actually paid the fee on June/KOOC-0/6. The payment year was from June/KOOC-0/0, 2004 to June/KOOC-0/0, 2005, and the monthly payment base of basic medical insurance was 634 yuan.

Three, flexible employees enjoy retirement medical treatment.

Retirement of flexible employees to enjoy basic medical insurance benefits must be approved by the municipal labor and social security administrative department.

Flexible employees reach the statutory retirement age and have paid the basic medical insurance for a total of years (continuous service in line with national policies can be regarded as the payment period). Men have reached 25 years and women have reached 20 years, and the actual payment period is not less than 15 years (for 1998 laid-off "4050" employees of state-owned enterprises, the actual payment period can be appropriately shortened, generally not less than 65438 years).

When flexible employees reach the legal retirement age, if the accumulated payment period or actual payment period does not meet the requirements, they can enjoy the basic medical insurance benefits for enterprise retirees in Taiyuan after paying in full with the average salary of employees in Taiyuan last year 100% as the payment base. Can not be filled, the balance of his personal account returned to him, no longer enjoy the basic medical insurance benefits. Flexible employees who enjoy medical insurance benefits for retirees will continue to pay medical insurance premiums for serious illness and enjoy medical insurance benefits for serious illness according to regulations.

Four, the basic medical insurance payment period of flexible employees according to the Taiyuan Municipal Labor and Social Security Bureau approved the basic medical insurance for employees when they retire.

Notice of Insurance Payment Period (Lao She Fa [2003] No.26). Article 2:

1, confirmed by the administrative department of labor and social security, before the implementation of the individual contribution system of old-age insurance, employees who meet the continuous length of service or working years stipulated by the state shall be regarded as and calculated as the payment period of basic medical insurance;

2, the basic old-age insurance after the implementation of individual payment system, the actual payment of basic old-age insurance premiums, as well as the calculation of the basic medical insurance payment period.

Five, flexible employees to participate in medical insurance management.

Flexible employees to participate in medical insurance, to the labor and social security administrative departments identified intermediary agencies, go through the formalities.

(a) to participate in medical insurance inspection materials

1, ID card or household registration book

2. Two recent bareheaded one-inch photos on a red background.

3. Those who have participated in medical insurance in Taiyuan shall carry a medical insurance manual and an IC card.

4. If the insurance is renewed within 60 days after the termination or dissolution of the labor relationship, a certificate of termination or dissolution of the labor relationship shall be provided.

5, regarded as payment period, carrying employee files, old-age insurance manual, basic old-age insurance payment receipt; Among them, "4050" employees of state-owned enterprises have been laid off and unemployed since 1998, and corresponding certificates should be provided.

(2) Insurance and payment procedures

1, fill in the Application Form for Flexible Employment in Taiyuan to Participate in Medical Insurance.

2. Intermediary preliminary examination, agency registration, application for IC card and medical insurance manual;

3. After the examination and registration in the medical insurance center, the intermediary agency shall fill in the Notice of Payment of Medical Insurance for Flexible Employees in Taiyuan.

4, flexible employment personnel by the notice of payment, within the prescribed time limit, to Taiyuan City Commercial Bank outlets to pay, the bank will "Shanxi Province social insurance fee collection special bill" the second copy of the payer retained.

(3) Intermediary services and agency projects

1. Establish medical insurance handling files for flexible employees and track services;

2, the agent to participate in the basic medical insurance registration, apply for ic card, medical insurance manual;

3. Calculate the medical insurance premium payable by flexible employees, fill in the payment notice, and notify them to pay to the designated bank within the prescribed time limit;

4. Go through the formalities of personnel increase or decrease, and summarize and declare the payment;

5. The agency application is regarded as the payment period;

6, the agent to apply for retirement medical insurance benefits;

7. The agent applies for filing in different places;

8. The agent applies for a refund of personal account balance;

9. Assist in handling special medical management procedures and expense settlement procedures;

10, assist in handling medical compensation procedures for serious illness.

Six, personal account management

After the flexible employment personnel pay the fees, the medical insurance center establishes a personal account for basic medical insurance and implements ic card management. The medical insurance premium included in the personal account of medical insurance is determined according to the age of flexible employees: those under 45 years old are included in the personal account of medical insurance according to 2.8% of the payment base; Those over 46 years of age will be included in the personal account of medical insurance according to 3.9% of the payment base; According to the regulations, the personnel who enjoy the retirement medical treatment shall be included in the personal account of medical insurance on a monthly basis according to 5% of the monthly average basic pension for retired employees of enterprises in this city.

Seven, medical insurance benefits transition system

Flexible employees participate in the basic medical insurance for the first time. Those who have paid for less than 6 months in a row only enjoy the treatment of individual account payment, and those who have paid for more than 6 months enjoy the corresponding treatment of overall payment.

Flexible employees who have participated in the basic medical insurance in the original unit, including those who have left the center due to enterprise bankruptcy and received a one-time resettlement fee, will continue to receive and pay the basic medical insurance within 60 days after the termination or dissolution of labor relations, and enjoy all the benefits of the basic medical insurance from the next month of payment, without implementing the transitional system of medical insurance.

Eight, medical expenses arrears management

After participating in the basic medical insurance, flexible employees shall fulfill their payment obligations in full and on time. Where arrears, from the next month to suspend their enjoyment of the overall fund payment treatment. If the arrears are less than 3 months, the hospitalization expenses incurred during the arrears period shall be paid according to the provisions of the relevant departments, but the maximum amount shall not exceed the amount paid by me; If the arrears exceed 3 months, it should be regarded as automatic insurance, but the personal account fund can continue to be used. Automatic stripping

If you are insured again after the insurance, you will enjoy medical insurance benefits according to the provisions of the first insurance.

Nine, flexible employment personnel medical management and medical expenses reimbursement settlement implementation of the "Interim Measures for the administration of basic medical insurance for urban workers in Taiyuan", "Interim Measures for the settlement of basic medical insurance for urban workers in Taiyuan".

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