Medical insurance is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance agency will give certain economic compensation to avoid or reduce the economic risks caused by illness and treatment. Do you know the proportion of medical insurance? The following is the proportion of supplementary medical insurance I have accrued. Welcome to reading.

Proportion of supplementary medical insurance

The Notice of the Ministry of Finance of People's Republic of China (PRC), State Taxation Administration of The People's Republic of China, on Enterprise Income Tax Policies Concerning Supplementary Endowment Insurance and Supplementary Medical Insurance (Caishui [2009] No.27) stipulates that since June 5438+ 10/day, 2008, according to the relevant national policies and regulations, the supplementary endowment insurance and supplementary medical insurance paid by enterprises for all employees who are employed or employed in this enterprise shall not exceed the employees respectively. The excess shall not be deducted.

Article 3 of the Notice of the Ministry of Finance and the Ministry of Labor and Social Security on Issues Related to Supplementary Insurance for Enterprises (Caishe [2002] 18) stipulates that the measures for supplementary medical insurance for enterprises should be linked with the local basic medical insurance system. The supplementary medical insurance fund for enterprises is used and managed by enterprises or industries in a centralized way, and is managed by separate accounts. Medical expenses used to subsidize employees and retirees with heavy personal burdens in enterprises shall not be transferred to individual accounts of basic medical insurance, nor shall individual accounts be set up separately or used for other expenses of employees in disguise.

According to the above regulations, the supplementary medical insurance premium paid by the enterprise for all on-the-job or on-the-job employees who meet the supplementary medical insurance regulations shall be deducted when calculating the taxable income; The excess shall not be deducted. Supplementary medical insurance funds that have been accrued but not actually paid shall not be deducted before tax.

Interpretation: What is the difference between supplementary medical insurance and social medical insurance?

Supplementary medical insurance is established to make up for the deficiency of social medical insurance. The specific differences between the two are as follows:

First, the scope of legislation is different.

Social medical insurance belongs to the category of social legislation, which embodies the interest relationship between the state, employers and workers, is protected by law, and is also the obligation of the state to workers. Supplementary medical insurance defines the rights and obligations of the insurance institution and the insured according to the scope agreed in the insurance contract, and the insurance contract is signed on the basis of equality, voluntariness, mutual benefit and reciprocity. The relationship between rights and obligations in supplementary medical insurance is regulated by civil law.

Second, the nature is different.

Social medical insurance is enforced by the state or local government through legislation in order to protect and improve employees' health according to the constitution, which does not depend on the wishes of the insured; As a social public welfare undertaking, it has a non-profit nature. Supplementary medical insurance is operated by social insurance departments or insurance companies in the form of economic leverage compensation, which is an aspect of social and economic life; It is voluntary participation, and the insured and the insurance institution are generated by signing an insurance contract on a voluntary basis; The supplementary medical insurance provided by commercial insurance companies is mostly for profit, which belongs to the category of commercial medical insurance and has some attributes of commercial insurance, but the supplementary medical insurance provided by social insurance departments is non-profit.

Third, the reciprocal relationship between rights and obligations is different.

The reciprocal relationship between rights and obligations of social medical insurance is based on labor relations. As long as workers fulfill their obligations to work for the society, they can get the right to enjoy basic medical needs. In a certain sense, the medical insurance premium paid by workers is not directly proportional to the medical insurance benefits, that is, the rights and obligations of social medical insurance are not equal. The rights and obligations of supplementary medical insurance are based on the contractual relationship. Because there is an economic interest relationship between the insurance institution and the insured, as long as the workers have the economic ability, they can get the corresponding rights by signing the supplementary medical insurance contract voluntarily and paying the insurance premium according to the contract.

Fourth, the treatment level is different.

Social medical insurance is based on the basic medical needs and social stability of the insured workers, and its insurance premium and medical insurance benefits are adjusted accordingly with the improvement of the financial affordability of the state or employers, the rise in prices and the improvement of social productivity. To determine the payment level of supplementary medical insurance, usually only the payment amount of the insured is considered, and other factors are not considered.

Fifth, different roles.

Social medical insurance is to protect the basic medical needs of workers, and everyone is equal before insurance. By collecting medical insurance premiums and paying medical insurance service fees, it is used to adjust income differences and social relations and maintain social equity. Supplementary medical insurance, on the other hand, pays more insurance premiums and benefits to meet workers' higher medical needs or other special medical needs according to their own economic income or the economic situation of their units, which does not have the function of maintaining social equity.

Expansion: medical insurance reimbursement

Scope of medical insurance reimbursement

Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth. For example, free medical care and labor insurance medical care in China. The medical expenses of employees in China are shared by the state, units and individuals to reduce the burden on enterprises and avoid waste.

The scope of medical insurance is very wide. Generally, medical expenses are distinguished according to the characteristics of medical services, including doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization miscellaneous expenses, operation expenses, and various inspection expenses. Medical expenses are all kinds of expenses incurred by patients to treat diseases, including not only doctors' medical expenses and operation expenses, but also hospitalization expenses, nursing expenses and hospital equipment expenses.

Proportion and scope of medical insurance reimbursement:

1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

5, hospitalization, medical insurance paid for 20 years, can enjoy medical insurance reimbursement after retirement.

The proportion and scope of reimbursement of rural cooperative medical insurance;

1, outpatient compensation:

(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.

(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.

(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.

(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.

2, hospitalization compensation

(1) Reimbursement scope:

A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

(2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals.

3. Compensation for serious illness

(1) town risk fund compensation: all inpatients who participate in the cooperative medical system whose medical expenses exceed 5,000 yuan at one time or throughout the year should be compensated by stages, that is, 500 1- 10000 yuan is 65%,10001-/.

The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.

Rural cooperative medical insurance does not belong to the scope of reimbursement:

1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;

2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;

4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;

5, within the scope of reimbursement, beyond the limit.

Matters needing attention

Tips: Medical insurance covers a wide range. Generally, medical expenses are differentiated according to the characteristics of medical services, including doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization expenses, operation expenses, and various inspection expenses. Medical expenses are all kinds of expenses incurred by patients to treat diseases, including not only doctors' medical expenses and operation expenses, but also hospitalization expenses, nursing expenses and hospital equipment expenses.

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