The difference between the unit paying medical insurance and the individual paying medical insurance.

The difference between the medical insurance paid by the unit and the medical insurance paid by the individual is as follows:

1, different types of insurance paid: five insurances and one gold paid by the company for employees, including endowment insurance, medical insurance, unemployment insurance, work injury insurance, maternity insurance and housing accumulation fund; Personal social security only includes endowment insurance and medical insurance. The concept of company paying social security is that the company must pay social security for its employees according to law, and the social security paid by the company is also called urban employee social security. Whether it is a company or an individual, it is mandatory to pay, which is a legal obligation of both parties and has legal effect.

2. Different payment: the company pays social security, that is, the company pays most of the expenses and the employees pay a small part. Maternity insurance and industrial injury insurance are paid by the company; Personal payment of social security is only pension and employee medical insurance, and the cost of self-payment is much higher, and there are fewer types of insurance. The concept of individual payment is that if you don't work in a company or unit, if you are a freelancer or unemployed, you can pay social security yourself. This is voluntary, not compulsory. Social security paid by individuals is also called social security for urban and rural residents.

3. Different payment bases: the company pays social security for employees according to the basic salary base; Individuals pay social security, and the payment base is divided into three grades: medium, high and low, which are selected according to their own conditions. Social security paid by the company includes pension, medical care, unemployment, maternity and work-related injury insurance. Individuals who pay social security only need to pay basic medical insurance and endowment insurance. Among them, pension, medical care and unemployment insurance are paid by companies and individuals, while maternity insurance and industrial injury insurance are paid by companies.

Medical insurance settlement procedure

Settlement procedures for hospitalization and outpatient treatment of special diseases

Designated medical institutions shall submit the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month.

Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

Emergency settlement procedure

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

Resettlement procedures for people resettled in different places

1. The personnel resettled in different places shall be designated as the designated medical institution of 1-2 by the unit to which they belong, and shall be reported to the medical insurance agency for the record.

2. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution where the disease occurs at the place of residence shall be paid in advance by themselves or their units. After the treatment, the unit shall settle the diagnosis and medical records, effective expense bills, compound prescriptions and hospitalization expense lists of the insured. Go to the social medical insurance agency on the specified date.

To sum up, if an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the fixed number of years stipulated by the state, he will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state; If it is not reached, it can be paid to the fixed number of years stipulated by the state.

Legal basis:

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

Article 58

The employing unit shall, within 30 days from the date of employment, apply to the social insurance agency for social insurance registration for its employees. If the social insurance has not been registered, the social insurance agency shall verify the social insurance premium it should pay. Employees-free individual industrial and commercial households who voluntarily participate in social insurance, part-time employees who do not participate in social insurance in the employing unit and other flexible employees shall apply to the social insurance agency for social insurance registration. The state establishes a national unified personal social security number. Personal social security number is a citizen's identity number.