How to calculate medical insurance Formula

Medicare belongs to a category of social security, mainly to protect the medical responsibility, is a national benefit. On the one hand, it can be insured with the disease, on the other hand, even if you are sick, and then pay the medical insurance, it can also be reimbursed. Therefore, the crowd with medical insurance is very much, the following let us bring you medical insurance how to calculate the formula of the relevant content, take a look at it.

A, medical insurance how to calculate the formula

Medical insurance formula: reimbursement amount = (total cost - the first personal burden - pure out-of-pocket expenses - starting standard gold) × reimbursement ratio.

The monthly health insurance premiums are parameterized by the salary, and the amount of unit contribution is:Contributed salary x 7.5%. Individual contribution: salary x 2%.

The formula for calculating the five insurance premiums is:

Pension insurance = contribution base x 8% (individual contribution rate) + contribution base x 20% (unit contribution rate)

Medical insurance = contribution base x 2% (individual contribution rate) + contribution base x 12% (unit contribution rate).

2. What if the medical insurance relationship is interrupted?

3 months to make up the required

Before and after the participants for the transfer of health insurance relations, the basic medical insurance premium interruption of less than 3 months and make up the interruption of the period of medical insurance premiums, in accordance with the provisions of the insured place to continue to participate in the premiums and enjoy the corresponding treatment. The number of years of employees' basic medical insurance contributions is cumulative.

The contribution period for retirees to enjoy basic medical insurance benefits is in accordance with local regulations.

The waiting period for entitlement to treatment is not paid

Considering the imbalance of regional economic development and the differences in the operation of the fund, there is no uniform provision at the national level for the waiting period for entitlement to treatment for the basic medical insurance participants who have made up for the period of interruption of medical insurance premiums.

In practice, the basic health insurance system, in order to prevent the moral hazard of selective participation in the insurance without illness to avoid the responsibility of participation in the payment of contributions, temporary participation in the enjoyment of the benefits of illness, to ensure the legitimate rights and interests of normal participation in the payment of contributions, and to safeguard the social justice and security of the fund, the localities have made specific provisions for the enjoyment of the benefits of the participant in the case of changes in the relationship of health insurance.

In practice, the general practice in most of the integrated areas is that individuals participating in the basic health insurance for employees will have to make up the relevant fees and continue to participate in the insurance premiums within three months after the interruption of the payment of contributions (there are some local regulations that stipulate six months), and will be entitled to the normal health insurance treatment from the next month after the payment of the fees, and will not have to pay the medical expenses incurred during the interruption of the payment of contributions.

If you don't pay your health insurance premiums within the stipulated period, there is a waiting period ranging from 3 to 6 months to enjoy the benefits. During the waiting period, you have to pay the basic health insurance premiums according to the regulations, but the medical expenses incurred will not be paid.

The national level of the residents' health insurance does not have a uniform provision for the waiting period after the payment of the interrupted period of health insurance premiums.

The local practice is to pay the next year's health insurance premiums from September to December of the previous year, and the entitlement period is from January 1 to December 31 of the following year. Generally do not support the enrollment and payment of premiums in the middle of the year, if the participants do not pay the premiums within the specified period, they will not enjoy the treatment.

Only a small number of coordinated areas support the current year to pay the current year's residents' health insurance premiums, but all set a waiting period ranging from 1 to 3 months to enjoy the benefits, and medical expenses incurred during the waiting period to enjoy the benefits are not paid.

Three, what is the difference between health insurance and social security

The difference between health insurance and social security:

(a) health insurance is a kind of social security, social security contains health insurance, social security includes a wider range;

(b) the concept of different. Social insurance is a social and economic system to provide income or compensation for the population incapacitated, temporarily out of work or loss due to health reasons. Health insurance is a kind of insurance to compensate for the medical costs associated with illness.

(C) the role is different.