What is the limit of social security card?

Annual amount of social security card medical account balance

The maximum reimbursement amount of medical insurance for urban workers is outpatient: 20,000 yuan; Hospitalization: 300,000 yuan;

Maximum reimbursement for medical insurance outpatient service for urban residents: 2,000 yuan; Hospitalization: 6.5438+0.7 million yuan. At present, rural areas, towns, hospital levels, patients' ages and other factors will have an impact on the initial reporting amount and reimbursement ratio.

The payment items included in the social security card include endowment insurance, medical insurance, work injury insurance, unemployment insurance and maternity insurance.

I. Endowment insurance

Endowment insurance is directly proportional to the payment period and payment base. Under the same conditions, the longer the insurance period, the higher the payment base and the higher the retirement benefits.

If the insured has paid the endowment insurance premium 15 years, but has not reached the retirement age, the unit shall continue to apply for social insurance according to the relevant laws on social insurance; Those who are flexible employees can choose to continue to participate in the insurance or go through the termination procedures after the pension insurance payment is over 15 years. If you stop participating in insurance, you will not be able to enjoy relevant social security benefits (such as medical insurance).

Social security was not paid 15 years when I retired. In general, the insured person can apply for continuing to pay the old-age insurance premium on a monthly basis in the name of an individual at the place where the household registration is located or in an area that meets the retirement conditions. If the payment period of the old-age insurance is still less than 15 after five years of renewal, you can apply for a one-time payment of the old-age insurance premium for the remaining months, and you can apply for retirement benefits after payment.

Second, medical insurance.

1. On-the-job employees apply for outpatient medical insurance.

According to the regulations, the unit pays 9.5% of the employee's salary every month and 2% of the employee's salary.

When you see the emergency department, use the amount included in the medical insurance in that year first, and then enter the self-payment part after use. Out-of-pocket amount 1500 yuan.

When the out-of-pocket expenses exceed 1500 yuan, part of the expenses can be reimbursed. The reimbursement rate varies from 50% to 75% according to the patient's age and hospital level.

2. On-the-job employee hospitalization medical insurance.

If you are hospitalized, as long as you have paid medical insurance before, most of the medical expenses can be borne by insurance.

But first, employees need to pay 1500 out of their own pockets, and the part exceeding 1500 can be reimbursed in proportion, and if your medical expenses exceed the maximum payment limit, you can also pay them in proportion by the additional fund.

3. Injured on the job

If it has been identified as a work-related injury, it is necessary to go through the work-related injury declaration process, and medical insurance cannot be reimbursed.

Third, industrial injury insurance.

1. According to the Regulations on Work-related Injury Insurance, an employee shall be deemed as a work-related injury in any of the following circumstances:

● Being injured by accidents during working hours and workplaces;

● Engaged in work-related preparation or finishing work in the workplace before and after working hours, and was injured by accidents;

● Accidental injuries such as violence during working hours and workplaces due to the performance of work duties;

● Suffering from occupational diseases;

● When going out to work, he is injured or his whereabouts are unknown due to work reasons;

● On the way to and from work, I was injured by a traffic accident that was not my main responsibility or an urban rail transit, passenger ferry or train accident;

● Other circumstances stipulated by laws and administrative regulations that should be recognized as work-related injuries.

● During working hours and jobs, he died of sudden illness or died after being rescued within 48 hours.

● Injured in activities such as emergency rescue and disaster relief to safeguard national interests and public interests.

● The employee was originally in the army and was disabled due to war or work-related injuries. He has obtained a revolutionary disabled soldier's certificate, and the old injury recurred after he went to the employer.

2, industrial injury insurance can enjoy the treatment

● Employees who suffer from accidents or occupational diseases at work are treated and enjoy medical treatment for work-related injuries.

● The food subsidies for employees who are hospitalized due to work-related injuries, as well as the transportation and accommodation expenses required for employees to seek medical treatment outside the overall planning area, shall be paid from the work-related injury insurance fund after being proved by medical institutions and reported to the agency for approval. The specific standards for fund payment shall be stipulated by the people's government of the overall planning area.

● The expenses for work-related injury rehabilitation treatment for workers with work-related injuries to medical institutions that have signed service agreements shall be paid from the work-related injury insurance fund if they meet the requirements.

● Workers with work-related injuries can install artificial limbs, orthotics, artificial eyes, dentures and wheelchairs and other auxiliary devices due to their daily life or employment needs, and the required expenses shall be paid from the work-related injury insurance fund according to the standards stipulated by the state.

● If an employee suffers from an accident or occupational disease at work and needs to suspend work and receive work-related injury medical treatment, the original salary and welfare benefits will remain unchanged during the period of unpaid leave, which will be paid by the employer on a monthly basis.

● Workers with work-related injuries who have been assessed as disabled and confirmed to need life care shall be paid by the work-related injury insurance fund on a monthly basis.

● If an employee is identified as disabled at work, he shall pay a one-time disability subsidy from the industrial injury insurance fund according to the disability level.

● If an employee dies at work, his close relatives shall receive funeral subsidies, pension for supporting relatives and one-time work-related death subsidies from the industrial injury insurance fund according to regulations.

Four. unemployment insurance

Unemployed persons who meet the following conditions shall receive unemployment insurance money from the unemployment insurance fund:

(a) before unemployment, the employer and I have paid unemployment insurance premiums for one year;

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

(three) registered unemployed and have job requirements.

Before unemployment, if I and the employer have paid a total of one year but less than five years, the longest period of receiving unemployment insurance benefits is twelve months; If the accumulated payment is over five years but less than ten years, the maximum period for receiving unemployment insurance benefits is eighteen months; If the accumulated payment is more than ten years, the maximum period for receiving unemployment insurance benefits is twenty-four months. If you are unemployed again after re-employment, the payment time will be recalculated, and the period of receiving unemployment insurance benefits will be combined with the period of receiving unemployment insurance benefits that should have been received but not received in the previous unemployment, and the longest period will not exceed 24 months.

Verb (abbreviation of verb) maternity insurance

1, unemployed or retired persons

If an employee is unemployed or has paid maternity insurance premium 12 months before reaching the statutory retirement age, during the period of receiving unemployment insurance premium or after the employee reaches the statutory retirement age, maternity medical expenses within the prescribed scope will be incurred, and he will enjoy the corresponding treatment according to the regulations, but he will not enjoy maternity allowance, and his unemployed spouse will not enjoy maternity insurance benefits.

2. Maternity insurance benefits and maternity medical benefits for employees

Maternity insurance for employees is higher than maternity medical treatment: maternity insurance for employees can reimburse many maternity medical expenses; In the basic medical insurance, the reimbursement of maternity medical expenses is only a lump sum of money after childbirth or abortion.

Maternity insurance benefits for employees can only be enjoyed by a fixed group of people, and reimbursement benefits for maternity medical expenses can be enjoyed as long as they participate in basic medical insurance.

Those who participate in employee maternity insurance need to pay maternity insurance 12 months to enjoy the corresponding treatment; /kloc-under 0/2 months, you can enjoy the reimbursement of maternity medical expenses in the basic medical insurance according to regulations, that is, one-time reimbursement.

The insured who has paid maternity insurance 12 months cannot enjoy maternity insurance and maternity medical treatment at the same time, but can only enjoy maternity insurance.

3. The specific treatment of maternity insurance

Workers can enjoy many benefits as long as they pay maternity insurance in full in the last month of childbirth and the accumulated insurance payment exceeds 12 months.

Legal basis:

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Sixteenth individuals who participate in the basic old-age insurance will receive the basic old-age pension on a monthly basis if they have accumulated contributions for fifteen years when they reach the statutory retirement age.

Individuals who participate in the basic old-age insurance and pay less than fifteen years when they reach the statutory retirement age can pay for fifteen years and receive the basic pension on a monthly basis; Can also be transferred to the new rural social endowment insurance or urban residents' social endowment insurance, enjoy the corresponding pension insurance benefits in accordance with the provisions of the State Council.

Thirty-sixth employees who are injured by accidents or suffer from occupational diseases due to work reasons and are recognized as work-related injuries shall enjoy work-related injury insurance benefits; Among them, those who lose their ability to work after the appraisal of their ability to work enjoy disability treatment.

Work injury identification and labor ability appraisal should be simple and easy.

Forty-fifth unemployed people meet the following conditions, receive unemployment insurance money from the unemployment insurance fund:

(a) before unemployment, the employer and I have paid unemployment insurance premiums for one year;

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

(three) registered unemployed and have job requirements.

Forty-sixth unemployed people, before unemployment, the employer and I accumulated contributions for more than one year but less than five years, the longest period of receiving unemployment insurance money is twelve months; If the accumulated payment is over five years but less than ten years, the maximum period for receiving unemployment insurance benefits is eighteen months; If the accumulated payment is more than ten years, the maximum period for receiving unemployment insurance benefits is twenty-four months. If you are unemployed again after re-employment, the payment time will be recalculated, and the period of receiving unemployment insurance benefits will be combined with the period of receiving unemployment insurance benefits that should have been received but not received in the previous unemployment, and the longest period will not exceed 24 months.