Social security hospitalization reimbursement formula

Basic medical insurance reimbursement has a knack for saving money.

Payment standard

The payment is divided into two parts, the employer pays 7.5% of the total salary and the individual employee pays 2% of the salary.

Freelancers pay 9.5% of the average monthly salary of employees in this city in the previous year. Retirees do not pay their own fees. (Up to now, the average wage of employees in Chengdu last year was 1 1584 yuan, 965 yuan per month. So it can be calculated that freelancers need to pay 9 1.7 yuan every month.

note:

1, the premium of basic medical insurance must be paid in full and continuously.

2, urban individual industrial and commercial households and freelancers, reached the statutory retirement age but the cumulative payment period is less than 15 years, should continue to pay in full 15 years; It can also be paid in one lump sum 15 years, and the payment standard is: the average salary of employees in this city in the previous year × payment years × (1+7%) payment years.

Hospital expense reimbursement formula

[One-time hospitalization medical expenses-(Qifubiaozhun+out-of-pocket expenses that should be borne by individuals+expenses not covered by basic medical reimbursement) ]×[(75+ age× 0.2) ÷100]

In this calculation formula, the minimum payment standard is based on the average salary of employees in this city in the previous year (the standards formulated since 1999 are all 8084 yuan, which has not changed so far), and 5% of them live in 1 level hospitals; 8% were admitted to secondary hospitals; 12% was admitted to a tertiary hospital.

Important tips

Everyone must pay attention here: because in a natural year, the basic medical insurance has a reimbursement limit, that is, the cumulative maximum can not exceed four times the average salary of employees in this city in the previous year. If Chengdu is taken as an example, the reimbursement limit is 1 1584× 4 = 46336 yuan, then if the one-time reimbursement expenses calculated according to the above formula are 48000 yuan, even the first reimbursement in this natural year can only be reimbursed at most 46336 yuan.

case analysis

First, hospitalization reimbursement

Generally speaking, the reimbursement rate of living in 1 hospital is higher than that of living in a tertiary hospital, and the higher the age, the greater the reimbursement rate.

For example, within 46,000 yuan.

Chen Mou, 40 years old, was hospitalized in a designated tertiary hospital and spent 30,000 yuan on medical expenses at one time (regardless of his own expenses and special expenses). Then, through the basic medical insurance, the amount of reimbursement that Chen Mou can enjoy this time is:

(30000-8084×12% )× [(75+40× 0.2) ÷100] = 29029.92× 83% = 24094.83 yuan.

The expenses that individuals need to bear are:

30000-24094.83 = 5905. 17 yuan

If you live in a designated 1 level hospital, the amount you can reimburse is:

(30000-8084× 5% )× [(75+40× 0.2) ÷100] = 29595.8× 83% = 24564.5438+0 yuan.

The expenses that individuals need to bear are:

30000-2456438+0 = 5435.49 yuan

Example 2: More than 46,000 yuan.

Liu, aged 50, was hospitalized in a designated tertiary hospital and spent 60,000 yuan on medical expenses (excluding self-funded and special needs). Then, the basic medical expenses that should be reimbursed calculated by the formula are:

(60000-8084× 5% )× [(75+50× 0.2) ÷100] = 59029.92× 85% = 50175.43 yuan.

However, according to the regulations, the accumulated reimbursement amount of basic medical insurance in a natural year cannot exceed four times the average salary of employees in this city in the previous year, and Chengdu is currently 46,336 yuan. The reimbursable expenses calculated by Liu through the formula have exceeded the upper limit.

Therefore, the actual expenses he can reimburse this time are 46,336 yuan, and the expenses that he needs to bear are as follows:

60000-46336 = 13664 yuan

B, outpatient reimbursement

Social security agencies have established individual accounts for basic medical insurance for each insured person. The amount in the personal account can be swiped at the pharmacy to buy medicine, and the outpatient medical expenses and hospitalization expenses can also be paid according to the regulations. When I go out to the clinic, if there is no balance in my personal account, I will pay in cash; Those who have savings are owned by themselves and can be inherited according to law.

Below, we will explain the incumbents, retirees and freelancers respectively.

In-service employee

First of all, all the personal contributions (that is, 2% of my monthly salary) are transferred to my personal account, and then the unit contributions are also transferred to my personal account. Therefore, the formula for calculating the monthly increase of personal account is:

Employees under 50 years old: (my monthly salary ×2%)+ (my monthly salary ×0.02%× my age)

Employees aged 50 and above: (my monthly salary ×2%)+ (my monthly salary ×0.035%× my age)

for instance

Wang is 30 years old, with a monthly salary of 1000 yuan. The total amount transferred to Wang's personal account every month should be: (1 0,000× 2%)+(10,000× 0.02 %× 30) = 26 yuan.

Jiang is 52 years old, with a monthly salary of 1200 yuan. The total amount transferred to Jiang's personal account every month should be: (1, 200×2%)+( 1, 200× 0.035 %× 52) = 24+21.84 = 45.84 yuan.

retiree

The calculation formula for the monthly increase of personal account is:

Last year, the average monthly salary of employees in this city was ×2%+ last year, the average monthly salary of employees in this city was ×0.035%× my age.

If the monthly basic pension of retirees is higher than the average monthly salary of employees in the previous year, it will be included in the calculation based on my monthly basic pension.

for instance

Zhang is 6 1 year old this year, and his monthly basic pension is 1000 yuan (higher than the average monthly salary of employees in Chengdu last year of 965 yuan). The amount that should be credited to a personal account every month is:

(1000× 2%)+(1000× 0.035 %× 61) = 41.35 yuan.

Huang is 62 years old, and his monthly basic pension is 800 yuan (lower than the average monthly salary of employees in Chengdu last year of 965 yuan). The amount that should be transferred to Huang's personal account every month is:

(965× 2%)+(965× 0.035 %× 62) = 40.3 yuan.

freelance journalist

The calculation formula for the monthly increase of personal account is:

Under 50 years old: the average salary of this city last year ×2%+ the average salary of this city last year ×0.02%× my age.

50 years old and above: the average salary of this city last year ×2%+ the average salary of this city last year ×0.035%× my age. (The average monthly salary in Chengdu last year was 965 yuan)

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.