What is provincial medical insurance and what is municipal medical insurance?

1, payment proportion and payment base of insurance premium rate:

Except maternity insurance, the provincial contribution rate is 0.5%, and the municipal contribution rate is 0.7%. There is no difference between the payment ratio of other types of insurance and the upper and lower bases.

2, the provincial medical insurance can be in any hospital for medical treatment and hospitalization (participated in the medical insurance designated hospitals).

Municipal medical insurance can only be treated and hospitalized in municipal hospitals (participating in designated medical insurance hospitals)

3. The payment base is different. The payment base of provincial social security is based on the average monthly salary of employees in the province last year, and the municipal social security is based on the city.

4. The provincial social security money will eventually flow to the funds managed by the provincial level, and the provincial social security money will eventually flow to the municipal social security.

5. Therefore, provincial social security has a wider scope of application, which is universal in the whole province, and municipal social security can only be found in the local market. (The qualification for buying a house is a bit different, because many places now implement purchase restrictions, and the social security paid in the province is not recognized, and only the social security of the city where you live can be paid. )

6. Provincial social security coverage, insured objects, rate policies, payment standards, work injury identification and labor ability appraisal methods, treatment payment standards, handling and information systems are unified throughout the province, while municipal social security is unified only in the whole city.

7. The scope of social security is different. The provincial social security value is based on the whole province, and the municipal social security refers to the whole city. The so-called overall planning scope refers to the scope where social security expenses are merged into the same scope for unified call.

8. The proportion of medical insurance reimbursement is different:

Urban medical insurance:

Provisions on the payment of general outpatient co-ordination fund for employee medical insurance

1, in the designated community health service center of medical insurance, the general outpatient service of township hospitals uses national essential drugs to cancel the deductible line, and the overall fund pays according to the prescribed proportion.

2. During the year, the medical expenses incurred by the insured in the general outpatient department of the designated medical institution are within the scope of the basic medical insurance catalogue.

Provincial medical insurance

In a natural year, the deductible line of general outpatient service is 1500 yuan, and the capping line is 10000 yuan; In terms of hospitalization, the deductible line of secondary and above medical institutions was 1.200 yuan for the first time, and the number of inpatients gradually decreased from 360 yuan to zero during the year. The deductible line of secondary and below medical institutions was 950 yuan for the first time, and the number of inpatients gradually decreased from 280 yuan to zero during the year, and the hospitalization medical insurance capping line was 1.4 million. The medical insurance expenses above the deductible line and below the capping line shall be paid by the medical insurance fund in accordance with the prescribed proportion. The part exceeding the top line of basic medical insurance shall be paid by the supplementary insurance for large medical expenses of employees in proportion within the limit, with the insured amount of 400,000. The above hospitalization expenses and special disease expenses are calculated together. Relevant medical insurance benefits can be found on the website of the Provincial Medical Insurance Center.

Legal basis:

People's Republic of China (PRC) 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 to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity. Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations. Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.