The full name is basic medical security, and it is also a social security system covering the population. Urban medical insurance includes urban employee medical insurance and urban resident medical insurance.
Urban residents’ medical insurance is a medical insurance system that mainly covers urban minors and unemployed residents who have not participated in urban employee medical insurance.
Urban employee medical insurance is urban employee medical insurance (sometimes referred to as urban medical insurance). The basic medical insurance premiums of urban employee medical insurance are paid jointly by the employer and the employee ***.
1. Urban employee basic medical insurance implements a unified account combination method:
Insured persons can enjoy inpatient medical care coordination, mutual assistance for serious illness, and special medical services while enjoying the outpatient lump sum fee of their personal accounts. All diseases are treated as lump sum. Among them: 1. The personal account funds are composed of two parts. First, all personal contributions of employees are included in the personal account; second, the basic medical insurance premiums paid by the employer and transferred to the personal account. The specific transfer ratio for those under 45 years old is based on the individual’s previous year. 0.5% of the total salary is allocated, those over 46 years old and before retirement are allocated 1% of the total salary of the previous year, and retirees are allocated 3.2% of the average annual salary of the employees of the paying unit in the previous year.
2. Inpatient medical care is paid from the overall fund, which is accounted for separately from individual accounts and does not crowd out each other. The minimum payment standard for the overall fund for that year is 10% of the average annual salary of the county's employees in the previous year. In 2006, The county second-level hospital is 700 yuan, the original first-level hospital in Chengguan area is 630 yuan, and the first-level hospitals in each township are 560 yuan; the maximum payment limit set by the county government is 3.6 times the average annual salary of employees in the county in the previous year, and the basic medical insurance in 2006 The capping line is temporarily 25,200 yuan, and the maximum annual cap for critical illness mutual aid is 80,000 yuan.
3. The reimbursement method for expenses below the cap line is: Medical expenses below the threshold are paid by the individual. For medical expenses above the minimum payment standard and below the maximum payment limit, after excluding the out-of-pocket expenses in the drug catalogue, first-level hospitals with an in-service expense of less than 3,000 yuan will have to pay 14% and retirees will have to pay 10.5%, and second-level hospitals will have to pay 16% and retire 12%, respectively. Level 1 hospitals have 18% in-service expenses and 13.5% in retirement expenses; some level 1 hospitals with RMB 3,001-10,000 have 10% in-service expenses and 7.5% in retirement expenses; level 2 hospitals have 12% in-service expenses and 9% in retirement expenses; and tertiary hospitals have 14% in-service expenses. , retirement contribution 10.5%; 10,001 yuan - capped line. Some first-level hospitals have an in-service contribution of 6% and a retirement contribution of 4.5%; a second-level hospital has an in-service contribution of 8% and a retirement contribution of 6%; a third-level hospital has an in-service contribution of 10% and a retirement contribution of 7.5%. .
4. Critical illness mutual aid refers to the capped line - 80,000 yuan, and its self-pay ratio is 8%; for some special diseases, insured persons can also enjoy lump sum treatment for special diseases.
Legal basis:
Article 25 of the "Social Insurance Law of the People's Republic of China" The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions and government subsidies. The government subsidizes the required personal contributions for people who enjoy the minimum living security, disabled people who have lost the ability to work, elderly people over 60 years old and minors from low-income families.