The medical insurance benefits for retired employees is one of the issues that attracts more attention. It is related to the construction of our country's people's livelihood and reflects the country's humanistic care. What does a retirement health insurance policy include? Many people must want to know. The following article will take Jiaxing City as an example to explain what is included in the retirement medical insurance policy.

Interpretation of retirement medical insurance policy

1. Payment of basic medical insurance premiums by insured units

1. Personal accounts are uniformly established and established by medical insurance agencies The managed agencies, institutions, and municipal enterprises shall declare and pay basic medical insurance premiums on a monthly basis based on 8% of the average monthly salary of employees at the municipal level in the previous year based on the sum of current employees and retired personnel. Regarding the guide to medical insurance reimbursement, I have just compiled relevant content. I hope it will be helpful to you: How to use social security and medical insurance? This article teaches you the reimbursement application process!

2. If the personal account is temporarily established and managed by the employer, 5.5% of the average monthly salary of employees at the city level in the previous year shall be declared on a monthly basis according to the number of insured persons in the unit. Pay part of the overall fund.

II. Provisions on the number of years of participating in and enjoying basic medical insurance payment

Employees who retire after July 1, 2001 will have a cumulative number of years of pension insurance payment (including deemed The age limit is no less than 25 years for men and no less than 20 years for women. They can continue to participate in and enjoy the employee basic medical insurance. Those who are dissatisfied should be replenished. The back-payment fee shall be based on the payment standard at the time of top-up. The employer shall be responsible for making up the unpaid amount, and the remaining payment shall be made by the individual employee.

3. Composition of basic medical insurance personal accounts

Retirees: 1. For those under 75 years old (inclusive), 4.5% of the average salary of city employees at the same level in the previous year will be included. ; Those over 75 years old are included in the calculation based on 5% of the average salary of city employees at the same level in the previous year. 2. Interest on deposit amount.

IV. Scope of use of personal accounts

Personal accounts are mainly used for outpatient medical expenses and drug purchase expenses of insured persons in designated medical institutions and designated pharmacies that comply with the provisions of basic medical insurance. The part of the medical expenses for hospitalization and prescribed diseases that should be borne by the individual (except for the part paid for by the individual) is applicable every year. If there is any balance at the end of the year, it can be carried forward to the next year for continued use.

5. Items that do not fall within the payment scope of the basic medical insurance pooling fund

According to Jiaxing City’s retirement medical insurance policy, the items that do not fall within the payment scope of the basic medical insurance pooling fund include the following A few:

1. Seeking medical treatment and purchasing medicines not in accordance with regulations or seeking medical treatment and purchasing medicines in non-designated medical institutions or non-designated pharmacies without approval.

2. Medical expenses incurred due to illegal crimes, suicide, self-mutilation, fights, drug abuse, alcoholism, etc.

3. Medical expenses during travel and outbound travel.

4. Traffic accidents, medical accidents, large-scale food poisoning and compensation liabilities of others should be paid.

5. Work-related injuries and relapse of old work-related injuries of employees included in the coverage of work-related injury and maternity insurance for female workers, as well as the cost of maternity and family planning surgeries for female workers.

6. Provisions on insured persons transferring to other places for medical treatment

Regarding the provisions on insured persons transferring to other places for medical treatment, the retirement medical insurance policy also clearly states: The insured persons shall be transferred to other places for medical treatment due to their illness and medical treatment. If you need to transfer to other places for medical treatment, you must first provide opinions from the ward (department) director of the designated hospital, fill in the "Jiaxing Urban Employees Basic Medical Insurance Transfer Hospital Application Form", and submit it after approval by the hospital's department in charge of the Basic Medical Insurance for Employees. The opinions will be signed and sealed. Submit it to the basic medical insurance agency for approval, and the medical insurance agency will issue a transfer letter of introduction, and you can then transfer to a targeted hospital in other places for inpatient treatment. Emergency and rescue patients can be hospitalized first, and the procedures can be completed within three working days.