What's the use of paying medical insurance?

The role of paying medical insurance: if you pay medical insurance, you can enjoy medical insurance according to law, and you can spend less money on medical treatment. Social security is a social and economic system that provides income or compensation for people who have lost their ability to work, are temporarily unemployed or suffer losses due to health reasons. Medical insurance is a kind of social security.

The purchase of social medical insurance has the following five functions:

First, it is conducive to improving labor productivity and promoting the development of production. Medical insurance is the inevitable result of social progress and production development. Conversely, the establishment and improvement of medical insurance system will further promote social progress and production development. On the one hand, medical insurance relieves the worries of workers, makes them work with peace of mind, can improve labor productivity and promote the development of production; On the other hand, it also ensures the physical and mental health of workers and the normal reproduction of labor.

The second is to adjust the income gap and reflect social equity. Medical insurance is an important means for the government to adjust the income difference and redistribute income by collecting medical insurance premiums and paying medical insurance service fees.

The third is an important guarantee for maintaining social stability. Medical insurance helps sick workers economically, helps to eliminate social instability caused by diseases, and is an important social mechanism to adjust social relations and social contradictions.

Fourth, it is an important means to promote social civilization and progress. The social system of medical insurance and social mutual assistance reflects the new social relationship of "one party in trouble and all parties support" by sharing the risk of disease costs among the insured, which is conducive to promoting social civilization and progress.

Fifth, it is an important guarantee for promoting economic system reform, especially the reform of state-owned enterprises.

Medical insurance (social medical insurance) is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The government formulates policies with the participation of both employers and employees.

How to have a medical insurance card:

Medical insurance card is a special card for personal account of medical insurance, which takes personal ID card as the identification code and stores detailed information such as personal ID card number, name, gender, payment and account capital consumption.

The medical insurance card is undertaken by the local designated agent bank, which is a multi-functional debit card of the bank. After the insured unit pays the fee, the local medical insurance department will entrust the bank to transfer the personal account payment to the personal medical insurance card of the insured employee at the end of the month.

The specific composition of medical insurance card, medical insurance card is divided into two accounts.

The medical insurance card consists of two accounts, namely, individual account and overall account. Part of the medical insurance paid by the unit is put into the overall account and part is put into our personal account. The proportion of medical insurance paid by employers is generally around 30% (the specific proportion varies from region to region). And our personal contributions are all credited to personal accounts.

What's the difference between individual account and overall account?

Personal accounts are used for:

(1) outpatient and emergency medical expenses;

(2) the cost of purchasing drugs in designated retail pharmacies;

(3) the basic medical insurance fund Qifubiaozhun below the medical expenses;

(4) medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.

The master account is used for:

(1) hospitalization expenses;

(2) medical expenses within 7 days before emergency observation and hospitalization;

(3) Outpatient medical expenses of chemotherapy and radiotherapy for malignant tumor after renal transplantation, renal dialysis and taking anti-rejection drugs.

How to reimburse the medical insurance card:

Outpatient: If you have a cold, go to designated medical institutions and retail pharmacies to buy medicine.

If the medicine you buy is within the scope of social security, you can swipe your medical insurance card. In this case, the money you swiped is the money in your personal account. If the money in the medical insurance card is not enough, you can only pay for it yourself.

Hospitalization: Hospitalization in designated hospitals after common diseases surgery.

Hospitalization medical expenses and expenses within the scope of social security will be automatically linked to our overall account when swiping the medical insurance card, and the part above the threshold and below the maximum amount can be reimbursed.

If there are some imported drugs and self-funded drugs for medical treatment, they are all paid by themselves, and medical insurance cannot be reimbursed.

Serious illness: hospitalization for major diseases such as cancer.

When suffering from major diseases such as cancer, the role of medical insurance is very small. Because of major diseases such as cancer, the cost is often very huge! Moreover, the drugs used are mostly imported drugs and self-funded drugs. The medical expenses caused by serious illness can never be solved by medical insurance.

Legal basis:

Social insurance law

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.