What is the impact of clearing the continuous payment period of medical insurance?

The impact of clearing the continuous payment period of medical insurance is as follows:

1, affecting the basic medical expenses and local supplementary medical expenses of the insured who enjoy the treatment of serious illness outpatient service;

2, the impact of the basic medical insurance fund payment amount;

3, affect the local supplementary medical insurance fund payment amount. Therefore, unless there are special circumstances, it is best not to deduct money.

Medical insurance reimbursement conditions:

1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital;

2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can be paid by the basic medical insurance fund according to regulations;

3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.

To sum up, unlike endowment insurance, once the payment of medical insurance is interrupted for more than 3 months, the eligibility for medical insurance benefits will be lost. Therefore, the medical insurance period does not accumulate. The actual payment period of the insured person participating in the basic medical insurance for urban workers with the unit during his employment can be calculated cumulatively; Stop enjoying medical insurance benefits from the month following the interruption of payment. If the insured pays the arrears within 3 months, the payment period during the arrears period is included in the actual payment period of individual medical insurance and can enjoy the treatment. If it is more than 3 months, the medical expenses will be entitled to medical insurance benefits after the first 13 month of the month of re-payment. Units pay medical insurance premiums and enjoy treatment from the next month of payment.

Legal basis:

Article 63 of People's Republic of China (PRC) Social Insurance Law

If the employer fails to pay social insurance premiums in full and on time, the social insurance premium collection agency shall order it to pay or make up within a time limit. If the employer fails to pay or repay the social insurance premium within the time limit, the social insurance premium collection agency may inquire about its deposit account in banks and other financial institutions; And can apply to the relevant administrative departments at or above the county level to make a decision on the allocation of social insurance premiums, and notify their bank or other financial institutions in writing to allocate social insurance premiums. If the balance of the employer's account is less than the social insurance premium that should be paid, the social insurance premium collection agency may require the employer to provide guarantee and sign a deferred payment agreement. If the employer fails to pay the social insurance premium in full and fails to provide guarantee, the social insurance premium collection agency may apply to the people's court for sealing up, distraining and auctioning the property whose value is equivalent to the social insurance premium that should be paid, and the proceeds from the auction will be used to offset the social insurance premium.