Medical expenses insurance refers to the insurance that the insurer provides insurance coverage for the medical expenses incurred by the insured in treating diseases. Medical insurance premium is conducive to improving labor productivity and promoting production development. It is helpful to eliminate social instability caused by diseases. Conducive to promoting social civilization and progress. When the medical insurance payment is staggered, the insured person or agent shall bring relevant information to the municipal medical insurance agency for refund.
Medical insurance is intertwined.
First, in terms of employee medical insurance, the refund is divided into four situations:
1. After the insured individual pays the medical insurance premium in one lump sum, he meets the conditions of enjoying the preferential rate of medical insurance payment and financial subsidy upon examination. If the insured person has paid according to the specified payment base and proportion, he may apply for refund of the preferential rates and subsidies he should enjoy.
2. If the payment is not made according to the specified payment base and proportion, the county-level medical insurance agency shall verify the amount of refund according to the payment standard before municipal co-ordination, and put forward an application for refund. After being audited by the Human Resources and Social Security Bureau and the Finance Bureau, it shall be reported to the Municipal Social Security Bureau for review. After being approved by the Municipal Human Resources and Social Security Bureau and the Municipal Finance Bureau, the fee can be refunded.
3. After the insured individual pays the normal annual fee, it meets the preferential policies of medical insurance upon examination, but if it turns into an insured employee or dies, it can be refunded according to the amount calculated by the preferential policies of medical insurance.
4. During the period of receiving unemployment insurance benefits, the individual insured has been insured and paid by the unemployment insurance agency, and at the same time participated in the employee medical insurance as an individual, resulting in repeated payment. I can apply for refund of the fees paid by individuals during the repetition period in the following year. If it's too much trouble, you can find someone to pay social security!
Two, medical insurance premiums will not be refunded in the following circumstances:
1. The insured pays medical insurance premiums in more than two insured units at the same time, and the medical insurance premiums paid by their units will not be refunded, and their individual accounts will be merged.
2. If the insured participates in employee medical insurance and resident medical insurance in the same period, the duplicate payment will not be refunded.
3. Before the publication of the social wage in the previous year, employees who have stopped medical insurance or been transferred by the unit will not be liquidated and refunded after the publication of the social wage.
4. Individual insured persons or urban and rural residents' medical insurance insured persons voluntarily choose to pay according to the first and second files, and may not ask for the refund of paid medical insurance premiums in the name of surrender or transfer.
5. If the insured individual pays the annual fee according to the first-class standard and dies within the insurance validity period, the part included in the overall fund and the large medical insurance premium will not be refunded.
6. Before the municipal co-ordination, the part of repeated payment made by the insured between different co-ordination areas in the city will not be refunded, and their personal accounts will be merged according to regulations.
The materials required for refund are as follows
1, my ID card;
2. Household registration book or household registration certificate;
3 residents' social medical insurance refund application form.
Medical insurance payment and multi-period refund processing flow
1. declaration: the insured person shall provide the corresponding filing materials to the social security offices of the streets within the jurisdiction, fill in the relevant forms, apply to the residents' medical insurance window of the medical insurance office, and provide information;
2. Audit: The staff of the street social security office shall audit whether the information provided by the insured meets the requirements according to the relevant documents; Fill in the application form for surrender of basic medical insurance for urban residents;
3. Handling: After the approval, the staff will enter the relevant forms into the social security system, generate the corresponding refund notice, print it after verification and inform the insured. Meet the conditions to give medical insurance surrender, issued by the "basic medical insurance for urban residents surrender notice";
legal ground
Article 90 of the Social Insurance Law stipulates that if the social insurance premium collection agency arbitrarily changes the base and rate of social insurance premium payment, resulting in underpayment or overpayment of social insurance premium, the relevant administrative department shall order it to recover the social insurance premium that should be paid or refund the social insurance premium that should not be paid; The directly responsible person in charge and other directly responsible personnel shall be punished according to law.