I want to know what social security includes.

Answers to questions related to social insurance

(Social Security Common Sense Literacy)

First, this question describes the answer:

1. Because many employees in our company are newly insured, they know little about social insurance. Therefore, according to the current policy, we can't answer everything in popular rather than official rigorous language. Just for literacy, not as the final basis for operation. Please forgive me if it is not rigorous.

The policy will change, so the situation will change. This answer is only for the current policy.

3. If you encounter anything you need to know and involve, please feel free to consult. Or self-help query social security official website, where there are the most accurate and up-to-date policies and notices.

2. What does social insurance include?

1. Social insurance includes five insurances: endowment insurance, unemployment insurance, work injury insurance, maternity insurance and medical insurance.

2. According to the national policy, local hukou, foreign urban hukou with Beijing Work Residence Permit and local farmers are given "maternity insurance". The rest of the household registration categories are provided with four insurances: old-age insurance, unemployment insurance, work injury insurance and medical insurance.

3. The following is a brief description of these four risks, in no particular order:

First: industrial injury

Workers who suffer accidents at work are entitled to medical treatment for work-related injuries after treatment and appraisal. Workers with work-related injuries should seek medical treatment in medical institutions that have signed service agreements. In case of emergency, they can go to the nearest medical institution for first aid. If the expenses required for work-related injury treatment meet the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs and the hospitalization service standard of work-related injury insurance, they shall be paid from the work-related injury insurance fund.

Disabled people can also enjoy relevant treatment after identification, so I won't elaborate here.

When a work-related injury occurs, the company shall be informed as much as possible while giving first aid, and the company shall submit the work-related injury identification within 30 days, and select two designated medical institutions for work-related injuries. If the patient's condition is stable, he should be transferred to a designated medical institution for treatment.

Second: unemployment

Unemployed persons who meet the following conditions can receive unemployment insurance:

(a) in accordance with the provisions of the unemployment insurance, units and individuals in accordance with the provisions of the payment obligation period of 1 year;

(two) the employment is not interrupted because of my will;

(three) have been registered as unemployed and have job requirements.

Unemployed persons enjoy other unemployment insurance benefits during the period of receiving unemployment insurance benefits.

Unemployed persons shall, within 40 days from the date of termination or rescission of labor (employment) or working relationship, go through the unemployment registration formalities at the social insurance agency where the household registration is located with the certificate of termination or rescission of labor (employment) or working relationship issued by the employer and relevant certification materials, which meets the conditions for receiving unemployment insurance benefits. Unemployment insurance is calculated from the date of unemployment registration.

The time limit for the unemployed to receive unemployment insurance benefits is determined according to the accumulated payment time before unemployment:

(a) the cumulative payment time 1 year but less than 2 years, can receive 3 months of unemployment insurance;

(two) the cumulative payment time of more than 2 years but less than 3 years, you can receive unemployment insurance for 6 months;

(three) the cumulative payment time of more than 3 years but less than 4 years, can receive 9 months of unemployment insurance;

(four) the cumulative payment time of more than 4 years but less than 5 years, can receive 12 months of unemployment insurance;

(five) if the cumulative payment time exceeds 5 years, the number of additional months shall be determined according to the method of paying unemployment insurance benefits for one month every full year. The maximum period for receiving unemployment insurance benefits shall not exceed 24 months.

The payment standard of unemployment insurance is 70% to 90% of the minimum wage in this city. The specific criteria are:

(a) the cumulative payment time is less than 5 years, according to the minimum wage of 70% payment;

(2) If the accumulated payment time is less than 5 years 10 year, it will be paid at 75% of the minimum wage;

(3) If the accumulated payment time is over 10 years but less than 15 years, it will be paid at 80% of the minimum wage;

(4) If the accumulated payment time exceeds 15 but less than 20 years, it will be paid at 85% of the minimum wage.

(five) the cumulative payment time of more than 20 years, according to 90% of the minimum wage payment.

(6) From the third month of/kloc-0, unemployment insurance will be paid at 70% of the minimum wage.

Third: maternity insurance

Maternity insurance means that married women enjoy maternity allowance for at least three months during childbirth, and can reimburse the expenses of examination and childbirth according to the limit. Abortion can also enjoy different amounts of allowances according to the number of months. If the woman does not have maternity insurance, the man does, but the child is born late, the man can enjoy a one-month bonus allowance.

Only by paying maternity insurance for 9 months in a row can the maternity expenses be reimbursed. This is the first time in July 2009 that Beijing has set a payment period for maternity insurance.

Maternity reimbursement includes three items: childbirth expenses (dystocia, natural delivery and cesarean section), medical expenses for family planning operations (other operations during childbirth) and maternity allowance. In the process of reimbursement, the maternity insurance foundation reimburses the unit, and then the unit issues it to the individual.

Maternity insurance can only be reimbursed if the maternity insurance employee has paid the fee for 9 months before delivery. If the continuous payment is less than 9 months, the first two expenses can be reimbursed, but the maternity allowance must be paid in advance by the employer. Maternity allowance can only be reimbursed if the insured employee continuously pays 12 months after delivery.

When going through the formalities, the enterprise shall submit the Employee's Handbook of Beijing Medical Insurance, Beijing Maternity Service Certificate and the birth certificate, (death or abortion), family planning operation certificate and fee voucher issued by the designated medical institution.

Fourth: basic pension

Pension means that when you reach retirement age and the accumulated payment reaches 15 years, you can receive retirement pension on a monthly basis in proportion at the place where you registered. Current policy: If the accumulated payment happens to be 15, you can get 20% of the local average monthly salary+1120 of your personal account (8% will be deducted every month) (basically, if the average payment is 15, you can now pay it to 200 yuan/month, personal account. The longer the payment period, the more you get, but there is no specific proportion now.

However, at present, rural hukou in other places does not enjoy some policies, and they all adopt a one-time liquidation system when the contract is terminated.

1those who joined the work after July, 1998, and whose personal payment period is less than 15 years (except for farmers who changed jobs), will not enjoy the basic pension treatment on a monthly basis after retirement, and the amount stored in their personal accounts will be paid to them in one lump sum.

Fifth: basic medical care

Basic medical insurance means that during the payment period, outpatient or hospitalization in designated hospitals can be reimbursed according to the prescribed proportion.

(Beijing) Different old-age insurances in social security have special pension accounts. Medical insurance basically does not exist. During the period of non-payment, the account is closed and you can't enjoy medical care. As long as you pay social security and medical insurance, you will begin to enjoy medical treatment.

According to Beijing Medical Insurance Regulations, if men have paid the basic medical insurance premium for 25 years and women have paid it for 20 years, they will go through the retirement formalities in accordance with state regulations, and if they receive the basic pension or retirement fee on a monthly basis, they will enjoy the basic medical insurance benefits for retirees and will no longer pay the basic medical insurance premium.

Confirmed by the administrative department of labor and social security, before April 1 2006, if the continuous length of service or working years of employees meet the national regulations, it will be regarded as the payment period of basic medical insurance.

3. What does the account category mean?

At present, the common household registration categories are divided into four categories: local town (local province/municipality directly under the central government), local village, foreign town and foreign village. The household registration book must prevail.

Four, how to link the household registration category with social insurance:

Urban hukou in this port enjoys five insurances: pension, unemployment, work injury, maternity and medical care. If the accumulated payment exceeds 15 years, the pension will be received monthly.

Local rural hukou (divided into rural labor and migrant workers, mostly rural labor) enjoys five insurances: pension, unemployment, work injury, maternity and medical care. If the accumulated payment exceeds 15 years, the pension will be received monthly according to the policy of "endowment insurance for urban and rural residents".

Urban hukou in other towns enjoys four insurances: pension, unemployment, work injury and medical treatment. Accumulated payment 15 years or more, and receive a monthly pension when you return to your domicile.

Rural hukou (divided into rural labor force and migrant workers, mostly rural labor force) enjoys four insurances: pension, unemployment, work injury and medical care. The termination of labor relations shall be liquidated;

Five, about the designated medical institutions:

When you are newly insured, you will be asked to choose a designated medical institution. Now all the new employees are selected in Jin Tao. Usually three to five. For example, specialized traditional Chinese medicine hospitals and specialized hospitals (such as orthopedic hospitals and gynecological hospitals) and 19 3A hospitals (such as Concord, Tongren, Friendship, Sino-Japanese Friendship, Xuanwu, etc. ) can also not choose reimbursement. It is generally recommended to choose a community hospital close to you. First, it is convenient, second, it is cheap, and third, the reimbursement rate is high.

If you choose this designated hospital and forget when you want to see a doctor in the future, you can find it in your medical blueprint. It says the company has no backup.

If you don't have time to go to a designated hospital because of emergency, you can go to another designated hospital belonging to social security (belonging to social security hospital but having no choice), hang up the emergency and keep the emergency prescription. If people don't hang you in the emergency room, there's nothing they can do.

As a result of moving or other reasons, the designated medical institutions can be changed once a year in May. If changes are needed, please ask the human resources department to fill in the change form.

Six, about medical reimbursement:

1. Take the year as the calculation unit, and every year 65438+ 101-65438+February 3 1 is an accumulation period. One is that the full deductible can be reported at any time; The other is that by the end of the year, 65438+ the following year1October 25 will be reimbursed centrally, and it will not be reported when it expires.

2. The reimbursement ratio is roughly as follows:

The first category, outpatient service. 50% will be reimbursed for the accumulated part exceeding 1800 yuan. Of the accumulated expenses 1800 yuan, 70% was paid by the mutual fund for large medical expenses. In other words, seeing a doctor in a designated community health service institution requires a lot of reimbursement. But you have to deposit a deposit of 1800 first, and keep the prescription and charge list well. 1800 is enough, and the above part can be submitted to the company (note that the bottom of 1800 has to be submitted, otherwise how will you know that you have enough bottom). If it's less than 1800 a year, you don't even have to pay it, you can only digest it yourself: (.

The second category, hospitalization, is about 80-97% according to the level of the hospital and the amount spent. This is too complicated. I'll consult you in detail when I meet the specific situation. Or the doctor in the hospital knows, you can ask. There is also an upper limit. The new policy is under discussion: the upper limit will be raised to seven times the payment base.

As for what diseases can be reported and what diseases can't be reported, there are some medicines at your own expense, so you should ask the doctor when you see a doctor. For example, I don't know if I can apply for beauty treatment. But normal diseases such as colds can be reported.

Regarding dental care, first, go to a designated hospital or a national specialized hospital; The doctor will tell you whether this hospital can report it. Even if the invoice is issued, it can't be reported to any private hospital.

4. Reimbursement procedure: according to the current policy, if you go out of the clinic, you should pay for it yourself first and then reimburse it. If you are hospitalized, you should pay at least 1300, and then pay more at your own expense according to the requirements of the hospital. You don't have to pay for the rest.

5. About medical cards: As for the medical cards to be implemented in the future, I won't reimburse them when I go abroad, and I don't have to pay the rest. The execution notice has not been received. Now I still take the blueprint to see a doctor. Let's wait until the card is issued.

6. What is required for reimbursement: there must be hospital bills and corresponding prescriptions. The registration fee of 3 yuan 5 yuan can be reported, but you have to ask them to stamp it for you.

7. What to bring when you see a doctor: You must bring a blueprint when you see a doctor, and let the blueprint be scanned with a home machine when you pay the fee. Also, when a doctor makes a prescription, he will ask, "at his own expense or medical insurance." If you say you have medical insurance, he will give you a medical insurance prescription. Generally, when prescribing "self-funded drugs", the doctor will tell you and ask for your consent.

8. About the pharmacy: About going to the pharmacy to get medicine. First of all, it must be a hospital designated by social security. Second, you have to have a prescription. As for the detailed operation, you can ask the pharmacy.

Seven, social security deduction ratio:

That's the proportion of money deducted now.

The social security base is approved once a year in April and may not be changed within one year.

In particular, it is pointed out that the payment base of endowment insurance and unemployment insurance for migrant workers in Beijing and other places is determined according to the minimum wage standard of employees in this city last year, and the year of 2009 is the monthly 800 yuan. The base of maternity insurance, medical insurance and industrial injury is fixed at 2236.

Urban hukou, the salary is less than 2236, and the base of maternity insurance, medical insurance and work injury is also 2236.

Don't ask me why the proportion of social wages in the country is so fixed, which is too complicated to explain. HOHO~

Closer to home, the proportion of expenses borne by individuals is as follows: basic pension 8%, unemployment 0.2%, basic medical care 2%+3; Industrial injury and maternity insurance are paid by enterprises, but not by individuals.

Eight, about the placement of rural labor in other cities, for example:

The cleaning of rural labor force in Haidian is as follows:

1, reduce First of all, medical care and four risks are reduced, and the reason for the decrease is that migrant workers terminate their labor contracts.

2. Go to the social security front desk and get two liquidation application forms, which shall be filled in by the liquidation applicant and stamped with the official seal, one for the four insurance counters and one for financial liquidation on the second floor.

3. The Labor Contract Cancellation Letter has no fixed format and is issued and sealed by the company.

4. Take the above information to the four risks collection counter for settlement, and the counter will print you a detailed list of the settlement amount.

5. If the liquidation applicant has paid unemployment insurance for one year, there is unemployment benefit; Otherwise, there will be no unemployment benefits. If there is unemployment benefit, you need to fill in loss form III and loss form IV in duplicate.

6. According to the liquidation schedule printed above, fill in the form 16 and the attached form 16 in duplicate.

7. Take the liquidation application form, liquidation details, missing table 3, missing table 4, table 16 and attached table 16 and go to the second floor to get the number for liquidation.

8. The Social Security Society will transfer the money to the company account within ten to fifteen days after handling.

9. The liquidation is completed.

Chaoyang District will apply for unemployment on 5- 12 as long as three items in table 16 are missing from table 4.

Reminder: you can't say that you are a resident. If you used to work in a town and later changed to a rural labor force, there will be unfortunate news that there may be mistakes in liquidation and unemployment benefits. If there is a mistake, you can only wait, because social security will report it to the city and then call you. The process will be long, and you may not get it. Employees themselves will suffer.

Reference documents:

Notice on adjusting the basic medical treatment in 2008

List of Class A/TCM/specialist hospitals that can be reported or not.

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