First, how to calculate the formula of medical insurance
Medical insurance calculation formula: reimbursement amount = (total expenses-individual pays in advance-purely self-funded items-Qifubiaozhun) × reimbursement ratio.
The monthly medical insurance premium is based on salary, and the unit payment amount is: payment salary ×7.5%. Individual payment: payment salary ×2%.
The calculation formula of five insurances and one gold is:
Endowment insurance = payment base ×8% (individual contribution ratio)+payment base ×20% (unit contribution ratio)
Medical insurance = payment base ×2% (individual contribution ratio)+payment base × 12% (unit contribution ratio).
Second, what should I do if the medical insurance relationship is interrupted?
Within 3 months, pay according to the regulations.
Before and after the insured handles the transfer of medical insurance relationship, if the payment of basic medical insurance is interrupted for no more than 3 months and the medical insurance premium is paid during the interruption, the insured shall continue to pay the insurance premium in accordance with the provisions of the insured place and enjoy the corresponding treatment. Accumulated calculation of payment period of basic medical insurance for employees.
Retirees enjoy the basic medical insurance payment period according to local regulations.
No medical expenses will be paid during the waiting period.
Considering the imbalance of regional economic development and the difference of fund operation, there is no uniform provision at the national level for the waiting period of basic medical insurance participants after paying medical insurance premiums during the interruption period.
In the practice of the basic medical insurance system, in order to prevent the moral hazard of selective insurance, such as avoiding the responsibility of insurance payment without illness, enjoying temporary insurance benefits when sick, protecting the legitimate rights and interests of normal insurance payers, and safeguarding social fairness and justice and fund security, various localities have made specific provisions on the treatment and enjoyment of the insured when the medical insurance relationship changes.
In practice, it is a common practice in most co-ordination areas that individuals who participate in the basic medical insurance for employees pay the relevant fees within 3 months (6 months in some places) after the interruption of payment, continue to participate in the insurance payment, and enjoy the medical insurance treatment normally from the next month after payment, and the medical expenses incurred during the interruption of payment will not be paid.
If the medical insurance premium is not paid within the prescribed time limit, there is a waiting period of 3 months to 6 months when re-insured. During the waiting period, the insured person needs to pay the basic medical insurance premium according to the regulations, but the medical expenses incurred will not be paid.
At the national level, there is no uniform regulation on the waiting period of residents' medical insurance after paying medical insurance fees during the interruption period.
The local practice is generally to pay the medical insurance premium of the following year in one lump sum from September last year to June 65438+February, and the treatment period is June 65438+1 October1June 65438+February 3 1. Generally speaking, paying for insurance halfway is not supported. If the insured fails to pay the fee within the prescribed time limit, he shall not enjoy the treatment.
Only the areas with overall points support residents' medical insurance expenses to be paid in the current year, but they all set a waiting period ranging from/kloc-0 to 3 months, and the medical expenses incurred during the waiting period will not be paid.
3. What is the difference between medical insurance and social security?
The difference between medical insurance and social security;
(a) medical insurance is a kind of social security, social security includes medical insurance, social security includes a wider range;
(2) Different concepts. Social insurance is a social and economic system that provides income or compensation for those who lose their ability to work, are temporarily unemployed or suffer losses due to health reasons. Medical insurance is an insurance to compensate medical expenses caused by diseases.
(3) Different functions.