The difference between provincial medical insurance and municipal medical insurance

Provincial medical insurance belongs to the management of provincial medical insurance center, and municipal medical insurance belongs to the management of municipal medical insurance center, all of which belong to urban employee medical insurance. The main differences are as follows:

First, the overall planning area is different.

Before there was no provincial-level overall planning for employee medical insurance in China, employee medical insurance was based on municipal-level overall planning. Within a province, the medical insurance relationship is paid in the place where the old-age insurance relationship is paid. According to the past management methods, the provincial social security is paid by the provincial social security center, so the medical insurance paid in the provincial medical insurance center belongs to the provincial medical insurance; The social security paid in the municipal social security center belongs to the municipal social security, and the medical insurance paid in the municipal medical insurance center belongs to the municipal medical insurance. According to the division of provincial administrative units, it is divided into several cities and provincial organs. Each city and the provincial organs are regarded as a different overall planning area. The medical insurance paid within the city belongs to the municipal medical insurance, and the medical insurance paid by the provincial organs in the overall planning area belongs to the provincial medical insurance.

Second, the payment object is different.

The main insured objects of provincial medical insurance are employees of provincial organs and institutions, employees of units stationed by the central government in provincial institutions, employees of enterprises stationed by the central government in provincial institutions and employees of provincial enterprises; Enterprise employees registered in the provincial administrative department for industry and commerce, personnel whose files are managed in the provincial talent exchange center, and personnel whose employee pension insurance is managed in the provincial social security center, etc. ; The insured objects of municipal medical insurance are people other than the provincial insured objects, including the staff of government agencies and institutions in this Municipality, employees of enterprises with household registration in this Municipality and flexible employees, and personnel whose files are managed in the talent exchange centers in cities and counties.

Third, the payment base is different.

The base of social security contributions is basically unified after provincial overall planning, and the upper and lower limits of social security contributions are uniformly defined by provincial social security departments. However, medical insurance has not yet achieved provincial overall planning, and the payment base stipulated by the overall planning area is still the payment base. It is also necessary to clarify the upper and lower limits of the payment base, but it is defined by the overall planning area. Municipal medical insurance is defined by the overall planning area of each city, and provincial medical insurance is defined by the provincial medical insurance center. Because the average wage level of employees in provincial organs is higher than that in cities, the payment base of provincial medical insurance is higher.

Fourth, designated hospitals are different.

Municipal medical insurance and designated hospitals are within the scope of this city, and hospitals outside the city cannot be designated hospitals. However, the provincial medical insurance designated hospitals can list provincial hospitals as designated hospitals, provincial hospitals scattered throughout the province as designated hospitals, and some municipal hospitals as designated hospitals.

Fifth, the relationship between provincial medical insurance and municipal medical insurance can be transferred to each other.

Although the provincial medical insurance and medical insurance do not belong to the same overall planning area, the medical insurance relationship can be transferred with the job transfer if it is transferred or the job changes. For example, if you transfer from Chengdu to the provincial government, you can transfer Chengdu's medical insurance to the provincial medical insurance center. The payment period can be mutually recognized, the payment period can be calculated cumulatively, and the medical insurance premium paid can be transferred.

Sixth, the cross-regional medical treatment of provincial medical insurance and municipal medical insurance belongs to medical treatment in different places.

If the paid provincial medical insurance goes to the municipal medical insurance designated hospital for medical treatment, it needs to be filed in a different place before it can be settled through the different medical treatment system. But now, with the acceleration of provincial medical insurance co-ordination, after the medical insurance is networked in the whole province, it is no longer necessary to file for medical treatment in different places. At the same time, if it is transferred from different places, such as medical insurance from Chongqing to Sichuan, it is necessary to first determine whether to transfer to provincial medical insurance or municipal medical insurance. For example, if you transfer to Chengdu and transfer to provincial medical insurance, you can only designate a provincial medical institution as a designated hospital. If you transfer to Chengdu, only one provincial hospital can be designated as the designated hospital.

To sum up, the difference between provincial medical insurance and municipal medical insurance is summarized in two sentences. Provincial medical insurance is handled in the provincial medical insurance center, and municipal medical insurance is handled in the city and county medical insurance center.

legal ground

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

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.