Differences between on-the-job and urban workers in medical insurance payment status categories

The differences between on-the-job and urban workers in the categories of medical insurance payment status are as follows:

1. On-the-job generally refers to people who have formal jobs in any unit or organization, including those who work in state-owned enterprises, foreign-funded enterprises and private enterprises.

Urban workers refer to those who work in urban units, including urban state-owned enterprises and institutions, urban foreign-funded enterprises and urban private enterprises.

2. There are differences in payment standards. According to the national regulations, the payment standard of medical insurance for urban workers is calculated according to a certain proportion of wage income, which is usually paid by individuals and units. However, the medical insurance payment standard of on-the-job personnel may be different according to different units and the nature of work, and the specific payment ratio and method need to be implemented according to the regulations of relevant units.

3, medical insurance payment, fill in the identity category for on-the-job and urban trade unions affect the payment standards, treatment and reimbursement scope and other differences. Specific differences need to be determined according to regions, units and policies.

4. There may be differences in medical insurance benefits and reimbursement scope. Generally speaking, the medical insurance benefits and reimbursement scope of urban workers will be more comprehensive, including basic medical insurance and serious illness insurance.

5. The medical insurance benefits and reimbursement scope of on-the-job personnel may be different according to different units and the nature of work, which needs to be determined according to the regulations and policies of relevant units.

On-the-job refers to individuals who are still working, and urban workers refer to people who are employed in cities and towns.

Employees pay more for medical insurance and enjoy higher treatment than residents' medical insurance. For example, if the reimbursement rate is higher, you can use your personal account to see a doctor in an outpatient clinic and buy medicine in a pharmacy. Finally, employees' medical insurance can enjoy retirement exemption after paying the prescribed number of years. There is no exemption for residents' medical insurance, and they must pay on time every year to enjoy the treatment.

Precautions for medical insurance reimbursement:

1. When the insured is admitted to or discharged from the hospital, they must go through the registration formalities at the medical insurance management window of the designated medical institution with the medical insurance card. If you need to be hospitalized, you need to pay a medical deposit first, and pay more and less after discharge.

2. If the insured person needs to be referred or transferred due to illness, he shall submit the referral opinions agreed by the attending physician of the hospital, and the unit where he works shall fill in the application form, report to the municipal (district) social security agency for approval and go through the referral (hospital) procedures. Among them, the referral is limited to provincial specialized hospitals, and the expenses need to be paid in advance. The reimbursement standard should be 10% first, and then the reimbursable amount should be calculated according to local regulations.

3. After discharge, the hospital will calculate the amount of medical insurance reimbursement and personal payment according to relevant policies. The amount of medical insurance reimbursement can be directly reimbursed at the hospital medical insurance settlement office, and the part paid by individuals needs to be settled by the insured.

4. The standard part of the deductible line for pooling funds after hospitalization will be different according to different local policies. Under normal circumstances, based on 10% of the average annual salary of employees in this city last year, the medical expenses for multiple hospitalizations are accumulated in a basic medical insurance settlement year.

To sum up:

Medical insurance for urban and rural residents is paid once a year, and they can be insured for one year regardless of their health or age. After the insured, the medical expenses within the scope of the insured's medical insurance policy can be reimbursed according to the regulations, and they can enjoy the general outpatient treatment, outpatient special disease treatment, hospitalization treatment and serious illness insurance treatment, and those who meet the conditions can also enjoy medical assistance.

Medical insurance reimbursement is limited by the amount, and the economic situation and policies in different regions are different, and the reimbursement ceiling is also different.

Legal basis:

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

Article 30

Paragraph (2)

Provisions: "Medical expenses shall be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance.