Employee large amount of medical mutual fund, what is the meaning of the large amount of medical expenses subsidies?

The oversized medical expenses and urban and rural residents medical commercial insurance critical illness insurance have some differences, such differences are mainly manifested in these two levels.

One is the payment method is different. Employee large amount of medical mutual fund, must be insured persons belonging to the unit and employees, under the premise of paying social medical insurance, independent payment of large amount of medical insurance costs, Chongqing City, for example, individual payment standard for each person 5 yuan per month per year 60 yuan, retired workers to be in the health insurance returned to the personal account deductions; urban and rural residents of the medical insurance, is not required to pay a large amount of medical insurance costs, the cost is to have medical insurance fund to pay the medical insurance. The cost is a medical insurance fund to pay, attributed to the second reimbursement characteristics.

The second is the cost reimbursement is different. Employee oversized amount of mutual help medical insurance contains mutual help way, the key to deal with the staff of the basic medical insurance personnel of the large medical expenses of the subsidy problem, large medical expenses include hospitalization and special outpatient costs, etc., the scope of the subsidy is more than the social health insurance fund to pay for the part of the maximum payment limit of the employee medical insurance for the last year the maximum payment limit for the social wage of four times, the employee medical insurance, the maximum payment limit is more than the maximum payment limit, the maximum payment limit is more than the social wage of four times. The portion above the maximum payment limit also needs to be subtracted from the costs below the starting line and the out-of-pocket expenses.

Residents of the medical insurance reimbursement category, for residents of the medical insurance fund in accordance with the provisions of the percentage of payment after the out-of-pocket expenses exceed a certain credit, in fact, is to do the medical insurance reimbursement of the starting line, and then by the assets of the critical illness insurance in accordance with the provisions of the medical compensation, the key to the assessment index is to pay their own out-of-pocket medical expenses beyond the starting line of the out-of-pocket expenses.

From the definition to analyze, the employee large amount of medical insurance is a mutual help, belongs to a kind of subsidy characteristics; residents of the big disease insurance also has the characteristics of the subsidy, but a lot of people also call this the second reimbursement. Need to reach the staff of large amount of mutual aid health insurance subsidy standard is very high, the residents of the medical insurance I pay part of the need to reach the starting line of reimbursement of the big medical insurance is relatively very easy to some.

Whether it is urban or rural residents oversized amount of mutual help medical insurance or urban residents big disease insurance, reimbursement standards are based on the current year to settle, that is, from January 1 to December 31 of each year as a settlement cycle. After a number of hospitalizations, the social health insurance fund pays more than the maximum payment limit for the part of the employee's hospitalization, you can run a large amount of medical insurance subsidies, the payment channel and social health insurance payment channel is the same.

The starting line for the reimbursement of households with major medical insurance is based on the per capita disposable income of urban residents in the current year, exceeding the starting line for major medical insurance above the cost of the amount of expenses paid in accordance with the enterprise to implement progressive reimbursement methods. For example, when the progressive cost of more than 100,000 in accordance with the 40% share of the cost reimbursement, progressive cost of more than 100,000 to 200,000 in accordance with the 50% share of the cost reimbursement, progressive more than 200,000 in accordance with the 60% share of the cost reimbursement.

Because our country's medical insurance is in accordance with the municipal institutions as a co-ordination area, oversized amount of mutual medical insurance and residents of large medical insurance, are based on the provisions of the co-ordination of the implementation of the area, for example, Kaifeng City, Henan Province, the large amount of medical insurance method requires that participants in a statistical analysis of the year, the existence of more than the maximum payment limit of the integrated fund of social medical insurance up to 120,000 yuan below the medical expenses, by the large medical assistance. The medical expenses are paid 90% by the commercial insurance of the medical aid for major diseases and 10% by the insured person.

Overall, the large medical expense subsidy is usually the urban employees' medical insurance, under the premise of paying social medical insurance, the urban and rural residents' oversized amount of mutual aid medical insurance staff, in the hospitalization or unique outpatient expenses exceeding the maximum payment limit of the basic medical insurance fund to carry out the subsidy, attributed to the characteristics of the supplemental medical treatment; the urban and rural residents' medical insurance The staff, according to the basic medical insurance fund unified household medical insurance, hospitalization fees in a social security year of medical expenses incurred in a part of the self-payment, exceeding the starting line of reimbursement of medical insurance for the second reimbursement of expenses.