Can social security be reimbursed if it stops?

Insurance Bian Xiao helps you answer, and more questions can be answered online.

Medical insurance is in arrears for one month, and hospitalization cannot be reimbursed.

On-the-job workers, flexible employees, migrant workers and other people who participate in the medical insurance for urban workers will have to wait 1 month for the medical insurance card to be used normally if it is in arrears. But the money in the personal account of the medical insurance card can still be used normally.

Failing to enjoy medical insurance benefits due to arrears and other reasons, the enterprise shall bear the responsibility.

Continue to pay medical insurance premiums during the payment period, and the waiting period starts from the following year 1 month;

Residents pay back the insurance premium during the non-payment period, and the waiting period is 3 months from the next month of payment;

The algorithm of waiting period for urban residents' medical insurance is related to the time when the insured pays back the expenses. For example, the insured person continues to pay the insurance premium during the medical insurance payment period, that is, from September to 65438+February, and the waiting period is from June to March of the following year, and enjoys the treatment from April to June. If the insured pays back the insurance premium during the non-payment period, the waiting period is 3 months from the next month of payment.

Employees can get medical insurance cards after two months of insurance. When employees seek medical treatment in designated hospitals, they shall show their medical insurance cards to prove their insured status and registration. Individuals do not need to pay first and then reimburse, and the part of medical insurance reimbursement can be directly settled by medical insurance and hospitals. Only at the time of checkout, the self-funded part is paid by the balance of the medical insurance card or cash.

Reimbursement ratio:

The hospitalization fee is directly settled by the hospital and the medical insurance center, and the insured only needs to pay the personal part (but if the company owes money and other reasons, it needs to pay at its own expense first). Outpatient service 1800, hospitalization 1300, can be reimbursed according to the amount of money spent.

First, the medical insurance deductible line 1800 is in the on-the-job outpatient and emergency department, and the accumulated part exceeds 1800 within one year, and the social security reimbursement is 50%.

Example: within one year, the outpatient and emergency departments and designated pharmacies spent 5,000 yuan, and the social security reimbursement was (5,000-1800) * 50% =1600 yuan, at their own expense: 3,400 yuan.

Second, the hospitalization and emergency policies are different. Every time the hospital is settled, the individual who reimburses the basic medical care does not have to pay it. For example, 50,000 yuan, the individual is responsible for 1 10,000 yuan, then the individual only pays 1 10,000 yuan, and the remaining 40,000 yuan is settled by the hospital and social security center.

However, there are still many personal benefits, and the large mutual assistance of medical insurance can also be reimbursed. In other words, if the personal conceit exceeds 1300 every time (after the second time, the pay line becomes 650), you can also take the bill to the company, and the company will declare it again. The part that exceeds 1300/650 this time will be reimbursed according to the proportion of segments.