How to reimburse flexible employment and medical insurance clinics?

The medical insurance premium paid by flexible employees is divided into two parts: the overall fund is used to pay the hospitalization medical expenses, and the proportion of medical insurance premium paid by flexible employees is included in the personal account. 5%, personal accounts are used to pay the medical expenses that individuals should bear according to regulations during outpatient and hospitalization.

The medical insurance reimbursement methods for flexible employees are as follows:

(1) The medical insurance premium paid by flexible employees is divided into two parts: the overall fund is used to pay the hospitalization medical expenses, and the proportion of medical insurance premium paid by flexible employees into personal accounts is 3. 5%, personal accounts are used to pay the medical expenses that individuals should bear during outpatient and hospitalization;

(II) The medical insurance premium paid by the insured with flexible employment shall be used for special purposes, and the principal and interest of the personal account shall be owned by the individual, and the remaining funds shall not be withdrawn, overdrawn or overspent, and the personal account shall not be lent to others for use;

(3) If the insured with flexible employment is transferred or dies in different places, it is necessary to go through the formalities of surrender and cancellation at the medical insurance department in time. Personal account balance fund principal and interest can be returned to me at one time, and the insured employee dies. The balance of personal account is inherited by the heir designated by me according to law;

(4) The minimum payment standard of the overall fund is 650 yuan, and the maximum payment limit is 30,000 yuan. In accordance with the provisions of the national and provincial basic medical insurance policies in 650 yuan within 30 thousand yuan and above medical expenses, by pooling funds and individuals to share the burden.

Medical insurance is one of the five insurances, which is divided into employee medical insurance and resident medical insurance. Employee medical insurance means that we work elsewhere, and the company helps us pay five insurances together, which cannot be separated. Those who have flexible employment or no job can participate in medical insurance alone, that is, residents' medical insurance.

The differences between employee medical insurance and resident medical insurance are as follows:

1, different insured objects

Medical insurance for employees: the insured objects are relatively narrow, mainly employees of enterprises and institutions, retired insured employees or flexible employees.

Residents' medical insurance: the coverage is wider, from children to the elderly, and people who have not participated in employee medical insurance can buy residents' medical insurance.

2. The payment entities are different.

Employee medical insurance: it is divided into two parts: unit payment and individual payment, which are handled by the unit, one part of the unit Jiaotong University and a small part of the individual.

Medical insurance for residents: All expenses shall be borne by individuals.

3. The payment amount is different

Employee medical insurance: the amount is relatively high, and it is paid in a certain proportion every month, and the proportion varies from place to place. For example, Shenzhen first-class medical insurance, the company undertakes 5. 2%, individuals pay 2%, and the total amount is at least 3,000 yuan per year.

Residents' medical insurance: the payment is small, generally only two or three hundred yuan.

4. Different payment methods

Employee medical insurance: paid on a monthly basis, generally before the th of each month. If the payment is suspended for more than 3 months, the overall account will be cleared and you cannot enjoy reimbursement.

Medical insurance for residents: paid annually, generally from September to 65438+February each year.

5. Different reimbursement treatment

Employees' medical insurance benefits are higher than residents' medical insurance, and the reimbursement rate of employees' medical insurance is 80%-90%, while that of residents' medical insurance is 50%-70%.

6. There is no personal account for residents' medical insurance.

Employee medical insurance has a personal account, and the money in the personal account can be used to see an outpatient clinic or buy medicine. Residents' medical insurance does not establish personal accounts.

I hope the above content can help you. Please consult a professional lawyer if you have any other questions.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.