The difference between the city and provincial health care insurance

Provincial health insurance is in the provincial health insurance center for health insurance, city health insurance is in the city and county health insurance center for health insurance, mainly belongs to the concept of a co-ordination area, in the health insurance did not realize the provincial co-ordination before, the provincial health insurance belongs to the management of the provincial health insurance center, city health insurance belongs to the management of the city health insurance center, the attributes of its belonging to the urban workers health insurance. The main differences are as follows:

First, the co-ordination area is different.

In China's employee health insurance has not been realized before the provincial level, employee health insurance is in accordance with the municipal level as a co-ordinating unit, within the scope of a province, the pension insurance relationship where to pay, health insurance relationship is also where to pay, according to the management of the past, the provincial social security center is responsible for the payment of social security at the provincial level, so in the provincial health insurance center of the payment of medical insurance, belongs to the provincial health insurance; in the municipal social security center of the payment of medical insurance, belongs to the municipal social security center. The social security paid at the municipal social security center belongs to the municipal social security, and the medical insurance paid at the municipal medical insurance center belongs to the municipal medical insurance. According to the division of provincial administrative units, divided into a number of municipalities and provincial organs, each municipality and provincial organs as a different co-ordination area, the health insurance paid within the municipalities belongs to the municipal health insurance, in the provincial organs of the co-ordination area of the medical insurance, belongs to the provincial health insurance.

Secondly, the contributors are different.

Provincial health insurance is mainly for the provincial organs and institutions of the workers, the central government to the provincial institutions of the unit workers, the central enterprise agencies stationed at the provincial level, the employees of provincial enterprises; in the provincial administration for industry and commerce of the enterprise workers registered, the file in the provincial talent exchange center management personnel, etc., workers' pension insurance in the management of the provincial social security center personnel, etc.; municipal medical insurance The insured objects of the municipal health insurance are the people outside the provincial insured objects, including the staff of the city's institutions, enterprise employees and household registration in the city's flexibly employed people, the files in the city and county personnel exchange center management personnel and so on.

Third, the contribution base is different.

Social security contribution base, in the realization of the provincial level after the pension insurance contribution base basically realized the unity of the provincial social security departments are unified by the upper limit and lower limit of social security contributions, but the medical insurance has not yet realized the provincial level, or to the integrated area of the contribution base as the basis for the contribution base, the same need to delineate the upper limit and lower limit of the base of the contribution, but by the integrated area to delineate. Municipal health insurance is determined by each municipal co-ordination district, while provincial health insurance is determined by the provincial health insurance center. Because the average wage level of provincial government employees is higher than that of municipalities, the contribution base for provincial health insurance is higher.

Fourth, the designated hospitals are different.

The municipal health insurance, designated hospitals are within the city, can not be outside the city hospitals as designated hospitals. However, provincial health insurance designated hospitals can be provincial hospitals as designated hospitals, can also be scattered throughout the province provincial hospitals as designated hospitals, but also some municipal hospitals can be identified as designated hospitals.

Fifth, provincial and municipal health insurance relations can be transferred to each other.

Provincial health insurance and health insurance, although not belonging to the same coordinating area, if the mobilization or job changes, etc., the health insurance relationship can be transferred with the transfer of work. For example, from the city of Chengdu to the provincial authorities to work, the city of Chengdu's health insurance can be transferred to the provincial health insurance center, the contribution period can be mutual recognition, contribution period can be calculated cumulatively, the payment of health insurance fees can be transferred.

Sixth, the provincial health insurance and city health insurance across the integrated area for medical treatment is a different place.

If you pay the provincial health insurance, to the municipal health insurance designated hospitals to see a doctor, you need to apply for the record of foreign medical treatment, to be able to through the foreign medical system can be settled, but now with the accelerated pace of the provincial health insurance co-ordination, health insurance to achieve the province after the network, there is no longer a need to apply for the record of foreign medical treatment. At the same time, if belonging to the foreign transfer, such as from Chongqing to Sichuan's health insurance, you need to determine whether to transfer to the provincial health insurance or municipal health insurance. For example, if you are transferring to Chengdu, you can only designate a provincial medical institution as the designated hospital if you are transferring to the provincial health insurance, and you can't designate a provincial hospital as the designated hospital if you are transferring to Chengdu, you can only designate the designated hospital in Chengdu as the designated hospital.

Legal basis

The National Health Insurance Bureau, Ministry of Finance on the expansion of the pilot long-term care insurance system of the guiding opinions (medical insurance issued [2020] No. 37) Article II Basic principles. Adhere to the people-oriented, focusing on solving the problem of long-term care protection for people with severe incapacity. Adhere to independent operation, focusing on establishing independent insurance, independent design and independent promotion. Insist on guaranteeing the basic, starting at a low level, determining expenditure with income, and reasonably determining the scope of protection and treatment standards. Adhere to responsibility***sharing, and reasonably divide the responsibility for financing and protection. Adhere to mechanism innovation, explore the operation mechanism for sustainable development, and improve the effectiveness of protection and management level. Adhere to the overall coordination, and do a good job with the relevant social security system and commercial insurance function.