The difference between medical insurance and social security for urban workers

1, Different applicable groups According to the introduction of our city, the applicable groups of medical insurance for urban employees are employees of all employers in cities and towns, including employees of enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, Hong Kong, Macao and Taiwan-invested enterprises, private enterprises, etc.). ), organs, institutions, social organizations, private non-enterprises and other units. The applicable population of medical insurance for urban residents is urban residents outside the coverage of basic medical insurance for urban workers and new rural cooperative medical care, mainly including minor residents, and refers to students in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools), preschool children and other minor residents under the age of 18; Elderly residents refer to urban residents who have reached the age of 60 for men and 55 for women; And other non-employed urban adult residents. College students will also be included in medical insurance coverage and become urban residents. 2. Medical insurance for urban employees with different payment methods shall be paid by the unit according to a certain proportion of the total wages of employees; Among them, the unit bears 7% of the total wages of employees, and the individual bears 2% of the salary base of his own contribution. This year, due to the impact of the economic crisis on the operation of enterprises, from April this year to 65438+February, the contribution of enterprises was reduced from 7% to 6%, reducing the burden on enterprises. Medical insurance for urban residents is paid by individuals through their neighborhood committees or schools (kindergartens), and the government gives subsidies on the basis of individual and family contributions. The funding standards for minor residents, adult residents and elderly residents are 100 yuan per person per year, 360 yuan and 360 yuan respectively, among which individual contributions are 150 yuan, 40 yuan and 280 yuan respectively; Government subsidies are 60 yuan, 60 yuan and 2 10 yuan. It can be seen that the raising standard of urban residents' medical insurance is far lower than that of urban workers' medical insurance, which is about 1/5 of the per capita raising amount of urban workers' medical insurance fund. 3. Employees who participate in medical insurance for urban workers can enjoy reimbursement of hospitalization expenses, reimbursement of outpatient expenses for overall diseases and personal account treatment for paying outpatient medical expenses, and the reimbursement ratio is higher than that of medical insurance for urban residents. After deducting out-of-range expenses, 75% will be reimbursed for the part with the minimum deductible of more than 5,000 yuan; 5000 yuan to 10000 yuan is partially reimbursed 80%; 10000 yuan or more will be reimbursed by 85%, and retirees will be increased accordingly10%; Co-ordinate the reimbursement of outpatient expenses for diseases, with 80% of on-the-job employees and 85% of retired employees. Residents who participate in medical insurance for urban residents can enjoy reimbursement of hospitalization expenses and reimbursement of outpatient expenses for diseases as a whole. Due to the low payment rate, the treatment is relatively low. After deducting the out-of-range expenses, the hospitalization expenses of insured residents will be reimbursed by 55%, and the part above the minimum deductible line (the same as the medical insurance for urban workers) will be reimbursed, and the cumulative maximum reimbursement for each medical year will be 30,000 yuan. Overall disease outpatient expenses, deductible (300 yuan) above, 50% reimbursement. 4. Medical management requires employees from different places to participate in the medical insurance for urban workers directly under the municipal government, and they must seek medical treatment in the designated hospitals of the municipal medical insurance in order to enjoy the reimbursement treatment. Residents who participate in medical insurance for urban residents, and minor residents under the age of 12 who are hospitalized due to illness (including 12) can go directly to designated hospitals with pediatric wards within the municipal area for medical treatment, regardless of hospital level; /kloc-For the first time, residents over 0/2 years old need to seek medical treatment in designated hospitals below Grade II (including Grade II) within the scope of the five districts. If it is really difficult to make a diagnosis and treatment due to the limitation of technical level, you can go through the referral procedures in the city and then transfer to a higher hospital for diagnosis and treatment. To sum up, the differences between urban residents' medical insurance and employees' medical insurance are mainly manifested in four aspects, namely, different clients, different payment methods, different treatment and different medical management requirements, but despite these differences, it will not affect the rights that the insured should enjoy. I hope the above article can distinguish between medical insurance for urban residents and medical insurance for employees.

Legal objectivity:

"Regulations on Basic Medical Insurance for Urban Employees" Article 7 The basic medical insurance premium shall be paid by both the employer and the employees. Among them, the employer pays 5%-7% of the total monthly salary of its employees, and the rate of employees paying basic medical insurance premium is not less than 2% of their total monthly salary. Article 8 The amount of employees' monthly wages is determined according to their actual total wages, but it shall not be less than 60% of the average monthly wages of employees in the city, county and autonomous county where they are located. The following medical insurance premiums that should be paid by themselves shall be paid by the employer. Article 29 of the Regulations on Basic Medical Insurance for Urban Employees shall pay the hospitalization medical expenses for serious and serious diseases according to the following methods: (1) Qifubiaozhun shall, in principle, be controlled at 9%- 1 1% of the average social wage of employees in cities, counties and autonomous counties in the previous year. (two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year. (three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses. The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.