What's wrong with the medical insurance participation status?

The reasons for the abnormal state of medical insurance participation are as follows:

1. If it is not paid in time, the social medical insurance premiums payable by employees whose medical insurance cards are suspended must be paid in the current month, and they can enjoy medical insurance benefits only next month according to regulations. If the payment of social insurance premiums is stopped in the current month, the medical insurance bookkeeping function will be stopped or suspended from the following month 1.

2. Hospital-side system failure Sometimes there will be system failure when the hospital settles, so it can only be settled at its own expense first.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation.

The establishment and implementation of the basic medical insurance system has gathered the economic strength of units and social members. With the government's funding, sick social members can get necessary material help from the society, reduce the burden of medical expenses, and prevent sick social members from "poverty due to illness".

legal ground

People's Republic of China (PRC) social insurance law

Twenty-third employees should participate in the basic medical insurance for employees, and the employer and employees should jointly pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations. Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.