What is the meaning of medical insurance waiting period

The waiting period of social security medical insurance refers to the time interval from the date of the participant's first contribution or the date of making up the contribution after the interruption of the contribution to the date when the medical insurance fund fulfills its payment responsibility. In general, the insurance liability provisions determine the policy in force, there will be a certain period of time after the waiting period, usually 90 days or 180 days, during this period of time the policyholder or beneficiary of the disease, the insurance company can not assume the insurance responsibility.

Social security is an important part of the social security system, and the main programs of social insurance are pension insurance, medical insurance, maternity insurance, unemployment insurance, and work injury insurance. Obviously, medical insurance is an indispensable part of social insurance.

The waiting period for medical insurance treatment refers to the period of time during which a participant who has been disconnected from medical insurance for more than three months is unable to enjoy medical insurance treatment immediately even if he or she joins the medical insurance again and needs to wait for a period of time before he or she can utilize the medical insurance to make reimbursement, and this period of time is the waiting period for medical insurance treatment. In the waiting period of the medical insurance treatment, the medical insurance can not reimburse the medical expenses within the scope of the medical insurance, and need to be borne by the participants themselves.

If a participant has paid for 2 years or more, and the interruption time is not more than 3 months, then there is no waiting period for the medical insurance treatment, and the participant will be able to enjoy the medical insurance treatment normally after re-paying the fees.

So, the insured person to buy social security medical insurance, it is best to buy as early as possible, so as to avoid the occurrence of disease in the waiting period will not be worth it.

How long does it take to get reimbursed for social security medical insurance? How much can I get reimbursed?

In general, the unit agreed to pay the employee's medical insurance in the next month onwards can be reimbursed for hospitalization, while the individual identity to pay the medical insurance generally need to pay half a year or more than a year to enjoy the reimbursement treatment.

As for how much the medical insurance reimbursement is, there is a starting line for the medical insurance reimbursement, which varies according to different levels of hospitals. The higher the grade, the higher the starting line. Generally speaking, it is 100 yuan for hospitals of the first level or below, 200 yuan for hospitals of the second level, 300 yuan for hospitals of the third level, and 400 yuan for non-city hospitals. Those who do not reach the threshold are not eligible for reimbursement, and those who do can be reimbursed in accordance with the regulations.

Social security medical insurance after enrollment in the next month onwards can be hospitalization reimbursement. As for the amount of reimbursement for different levels of hospitals, the starting standard, its reimbursement rate will be different. However, it is important to note that medical expenses need to be above the threshold to be reimbursed in accordance with the relevant regulations.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 2: The State establishes a system of social insurance covering basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, and maternity insurance, and guarantees the right of citizens to obtain material assistance from the State and society in the event of old age, sickness, industrial injury, unemployment, or maternity in accordance with law. and society in the event of old age, sickness, industrial injury, unemployment or maternity, in accordance with the law.

Article 26: The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 Medical expenses that conform to the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with the state regulations.

Article 32 If an individual is employed across the integrated region, his basic medical insurance relationship shall be transferred with him, and the years of contribution shall be cumulative.

Article 74 The data necessary for the work of social insurance shall be obtained by the social insurance administration organizations through their business operations, statistics and surveys, and shall be provided by the units and individuals concerned in a timely and truthful manner.

Social insurance agencies shall establish files for employers in a timely manner, keep complete and accurate records of social insurance data such as the number of persons participating in social insurance and the amount of contributions paid, and properly keep the original vouchers for registration and declaration, as well as the accounting vouchers for payment and settlement.

Social insurance agencies shall record in a timely, complete and accurate manner the contributions made by individuals participating in social insurance and by employers on their behalf, as well as records of their individual rights and interests, such as the enjoyment of social insurance benefits, and shall regularly send the record sheets of individual rights and interests to the individuals free of charge.

Employers and individuals can inquire and check their records of contributions and social insurance entitlements with the social insurance administration organization free of charge, and request the social insurance administration organization to provide social insurance consulting and other related services.