How to refund the advance payment for medical insurance?

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Personal medical insurance can be refunded.

First, the refund of overpaid medical insurance premiums for employees.

(a) to participate in employee medical insurance in an individual capacity (hereinafter referred to as individual insurance) policy factor refund, should be strictly based on the policy documents, objective and fair treatment.

1. According to the implementation of the spirit of the above-mentioned documents and the payment standard for wholesale payment before municipal overall planning, the county medical insurance agency will verify the refund amount, put forward a refund application, and report it to the municipal social security bureau for review after being audited by the county human resources and social security bureau and the Finance Bureau. Refunds can only be made after the approval of the Municipal Human Resources and Social Security Bureau and the Municipal Finance Bureau.

2, the individual insured according to the annual normal payment, audited in line with the preferential policies of medical insurance, but turned to employees insured or died, according to the amount calculated by the preferential policies of medical insurance refund. The specific refund standard shall be implemented in accordance with the relevant provisions of this item 1.

3. During the period of receiving unemployment insurance benefits, the individual insured has been insured and paid by the unemployment insurance agency, and at the same time participated in the employee medical insurance as an individual, resulting in repeated payment. He can apply for refund of the expenses paid by the insured individuals during the repeated period in the following year (the funds that have been included in the personal account during the repeated period should be deducted).

(two) the refund of the death of the individual insured shall follow the corresponding relationship between the payment and the treatment period, and seek truth from facts.

1. If an individual insured person who pays a lump sum according to the second standard dies after enjoying the medical insurance benefits (including personal account) corresponding to the payment according to the regulations, it shall still be handled according to the No.58 document of the People's Society, that is, according to the standard of personal account in the month of his death and the remaining years of one-time payment (calculated to the current month), the remaining years of personal account will be returned in one lump sum, and the part included in the overall fund and large medical insurance premium will not be returned.

Insured individuals pay the annual fee according to the second standard, and enjoy the medical insurance benefits (including personal accounts) corresponding to the payment in accordance with the regulations and die. In the remaining months of the year, the personal accounts will be refunded in one lump sum, and the part included in the overall fund and the large medical insurance premiums will not be refunded.

2. If an individual insured person dies before June 65438+1 October 3 1 the following year after paying the one-time medical insurance premium, his legal successor or designated beneficiary may apply for full refund of the corresponding insurance premium after June 65438+1October1the following year. The individual insured who paid the annual fee died before June 65438+1October 3 1 of that year, and his annual medical insurance premium can be fully refunded by his legal heir or designated beneficiary.

(three) the repeated payment of individual insurance and unit insurance, as well as the refund of the overpaid part after retirement, should ensure that the payment period is continuous and the treatment is not heavy.

1. After the insured individual pays the medical insurance premium on an annual basis, he will pay it repeatedly with the insured unit in our city in the middle of the year, and he can apply for refund of the expenses paid by the insured individual during the repeated period in the following year (the funds that have been included in his personal account during the repeated period should be deducted).

2. Individual insured persons continue to pay fees after going through retirement procedures, and if they meet the payment period of medical insurance upon examination, they may apply for refund of medical insurance premiums that exceed the payment period stipulated by medical insurance after retirement (except for large medical insurance premiums). After reaching the payment period of medical insurance, the personal account shall be liquidated according to the retirement standard and the number of overpaid months, and the overpaid part shall be deducted when the refund is made.

3. The insured employees have met the payment period of medical insurance when they retire due to the lagging retirement procedures of the insured units. After retirement, after deducting the overpaid medical insurance premium, the balance will be included in the employee's personal medical insurance account and returned to the unit. Personal accounts are liquidated according to retirement standards (excluding overpayment), and the difference in medical treatment formed during the period is paid by the insured unit with reference to the relevant provisions of medical insurance. For the lag caused by the examination and approval of the human resources and social security department, the difference in medical treatment formed during the period shall be paid by the medical insurance fund according to the regulations.

(4) Other refunds.

Before the municipal co-ordination of medical insurance, it is clear that the medical insurance premiums paid by the insured units or individuals should be returned to the districts and counties, and handled in accordance with the principle of locking projects, locking standards and locking heads. By the county-level medical insurance agencies to apply for a refund, the county-level human resources and social security bureau, the Finance Bureau after the audit, reported to the Municipal Social Insurance Bureau for review, after the approval of the Municipal Human Resources and Social Security Bureau, the Municipal Finance Bureau, a refund can be made.

Two, the treatment of overpaying residents' medical insurance premiums:

(a) after the insured person has paid the residents' medical insurance premiums in full, if the insured person meets the conditions for enjoying financial subsidies upon examination, the amount of financial subsidies paid by the insured person shall be refunded. If the insured paid the residents' medical insurance fee in full during the period from March 2065 438 to June 30, 2065438 +03, it will be refunded according to the standard of 280 yuan/person.

(two) for the insured (including college students) who have paid the residents' medical insurance premiums in accordance with the regulations and obtained the qualification of participating in the insurance subsidies with the approval of the relevant departments, the amount of subsidies they should enjoy shall be refunded.

(3) If the insured dies before June 65438+1 October1of the following year, his legal successor or designated beneficiary may apply for a refund of the medical insurance premium paid by the individual.

Three, the insured unit or the insured person in the following cases repeated payment will not be refunded:

(1) If the insured pays medical insurance premiums in two or more insured units at the same time, the medical insurance premiums paid by their units will not be refunded and their individual accounts will be merged.

(2) If the insured participates in medical insurance for employees and residents in the same period, the duplicate payment will not be refunded.

(III) Before the publication of the average wage of employees in non-private units in cities and towns in the previous year (hereinafter referred to as social wage), employees whose social wage was stopped by the unit or transferred after the publication of social wage shall not be liquidated and refunded.

(IV) Individual insured persons or urban and rural residents' medical insurance insured persons voluntarily choose to pay according to the first file and the second file, and may not ask for the refund of paid medical insurance premiums in the name of surrender or file transfer.

(five) the insured person pays the annual fee according to the first standard, and if he dies within the validity period of the insurance, the part included in the overall fund and the large medical insurance premium will not be refunded.

(six) before the municipal co-ordination, the repeated payment of the insured between different co-ordination areas in the city will not be refunded, and their personal accounts will be merged according to the regulations.

Four, to meet the conditions of refund of the insured units or individuals, according to the following procedures:

(a) by the unit or I to the insured medical insurance agencies to apply for a refund, fill in the "insured unit (individual) medical insurance refund application form" (annex 1), explain the reasons for applying for a refund and provide relevant supporting materials.

(2) The medical insurance agency at the place of acceptance shall review the application for refund, and send it to the medical insurance agency at the place where the overpayment occurs to review the matters and amount of refund. Those who meet the requirements shall be reported to the local Human Resources and Social Security Bureau and Finance Bureau for examination and approval by the medical insurance agency in the place where they are accepted (except Item (1) 1 and Item (2) of Article 1 of this Notice), and those who do not meet the requirements shall be informed of the relevant reasons.

(three) the refund approved by the local human resources and Social Security Bureau and the Finance Bureau shall be paid to the applicant unit or individual in time through the social security card with financial function or the designated bank account within the month. Among them, the refund of the overpaid part of the year was extracted by the collection households, which offset the income of the year; In previous years, the overpaid refund was extracted from the financial special account and classified as other expenses. Wolf. com

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