2022 The difference between the first and second grade of Foshan social security.

Many people don't know the difference between the first and second grade of Foshan medical insurance. In fact, it is the difference between financing (payment standard) and treatment. Today, I will tell you the difference between the first and second grade of Foshan medical insurance from two aspects.

According to the level of financing and treatment, the basic medical insurance in Foshan is divided into

First gear (no personal account)

and

Second file (including personal account)

Two grades.

1. The employees (including government agencies and institutions) who have established labor relations with the employer are unified as a whole, and the employer can choose to participate in the first or second gear independently.

2, the city's household registration flexible employment personnel can participate in a job in the domicile.

3. Non-employees registered in this Municipality, children of non-registered students studying in this Municipality (including newborns) and qualified migrant workers (including Hong Kong, Macao and Taiwan) are insured as residents. Residents only participate in the first gear.

4, the unemployed during the period of receiving unemployment insurance, to participate in the second file, should pay the basic medical insurance premiums (including units and individuals to pay part) from the unemployment insurance fund to pay, individuals do not pay the basic medical insurance premiums.

5, industrial injury insurance in one to four disabled workers to terminate the labor relationship, go through the formalities of disability (one-time enjoy disability benefits and terminate the industrial injury insurance relationship except), by the industrial injury insurance fund every month according to the second file to pay the basic medical insurance premium (including units and individuals to pay part) to its legal retirement age.

The difference between first gear and second gear:

First, the proportion and base of payment.

Payment base:

1. Employers, individual employees and flexible employees pay monthly fees based on the average monthly salary of employees in this city in the previous year;

2, finance, individual residents to the city's annual per capita disposable income as the base for the annual payment.

Payment rate:

1, the total rate of employees participating in the first stage of basic medical insurance is 4%, of which the total rate of employers' individual contributions and employees participating in the second stage of basic medical insurance is 5%, and the total rate of employers' individual contributions and flexible employees participating in the first stage of basic medical insurance is 4%, all of which are individual contributions.

4, residents to participate in the basic medical insurance file, starting from 20 19, the total rate is 4%, including two financial subsidies and benefits for individuals.

The treatment of first-class and second-class medical insurance is basically the same. The main difference is that the first-class basic medical insurance does not establish a personal account, and medical expenses are no longer paid to the personal social security card every month; The second file has a solidified personal account every month.

The first kind of treatment includes: hospitalization, family sickbed treatment, outpatient treatment for specific diseases, outpatient treatment for chronic diseases, general outpatient treatment, one-time maternity medical subsidy and serious illness insurance treatment;

Secondary treatment includes: primary treatment and personal account treatment.

The standard of treatment is as follows:

deal with

A class of medical institutions

Secondary medical institutions

Three types of medical institutions

Payment limit (Note: hospitalization of RMB 300,000 yuan includes payment limit for door-to-door and door-to-door payment)

Payment line

Reimbursement ratio

Payment line

Reimbursement ratio

Payment line

Reimbursement ratio

(yuan/time)

(%)

(yuan/time)

(%)

(yuan/time)

(%)

Hospitalization (including family beds)

300

95

600

90

1200

85 remarks 1

0.30 million yuan

Mente

(16 species)

not have

95

not have

90

not have

85 Remarks 2

Low-end 4500 to 5500 yuan

Mid-range 4 to 1 ten thousand yuan

High-grade 65438+ ten thousand yuan

Menman

(22 species)

not have

Eighty-five

not have

80

not have

75

4500 to 15000 yuan

General outpatient service

not have

90

not have

70

not have

40

not have

critical illness insurance

In a natural year, the medical expenses included in the compensation scope of serious illness insurance shall be paid by the serious illness insurance fund 60%; 70% of the total amount exceeding 50,000 yuan (inclusive) to 654.38+10,000 yuan shall be paid by the serious illness insurance fund; 80% of the accumulated part exceeding RMB 654.38+10,000 (inclusive) shall be paid by the serious illness insurance fund.

0.30 million yuan

In a natural year, if the cost of special drugs for serious diseases is more than 30,000 yuan and less than10.5 million yuan (including10.5 million yuan), 70% will be paid by the serious illness insurance fund. (There are 12 targeted drugs such as Iressa, Trocquer, Kemena, Secorum, Endo, Avastin, Herceptin, Taixinsheng, Dasina, Stacey, velcade, Albee, etc., which are suitable for seven major diseases such as lung cancer, gastric cancer, breast cancer, nasopharyngeal cancer, leukemia, lymphoma and colorectal cancer).

ten thousand yuan

One-time maternity medical subsidy

pay

The standard is: vaginal delivery 1500 yuan, and delivery of cesarean section and twin pregnancy is 3000 yuan.