The difference between civil servants’ social security and employee social security: 1. Civil servants’ medical insurance is mainly for civil servants and their families, including staff of state agencies, institutions, public hospitals, public schools and other public departments.
Employee medical insurance is aimed at enterprise employees and their families, including employees and retirees of enterprises, agencies, institutions, social groups and other organizations.
2. The coverage of civil servant medical insurance and employee medical insurance is also different.
Civil servant medical insurance mainly includes basic medical insurance, critical illness medical insurance and supplementary medical insurance, with a relatively wide coverage.
Employee medical insurance mainly includes basic medical insurance and critical illness medical insurance, and the coverage is relatively narrow.
3. Payment standards The payment standards for civil servant medical insurance and employee medical insurance are also different.
The payment standards for civil servant medical insurance are uniformly formulated by the government, and are generally paid jointly by units and individuals.
The payment standards for employee medical insurance are paid jointly by enterprises and individuals. The payment ratio is generally that enterprises pay more and individuals pay less.
4. Reimbursement ratios The reimbursement ratios of civil servant medical insurance and employee medical insurance are also different.
The reimbursement ratio of civil servant medical insurance is generally higher, generally above 80%, and can even reach 100% in some areas.
The reimbursement ratio of employee medical insurance is relatively low, generally between 60% and 80%.
To sum up, civil servant medical insurance and employee medical insurance are both medical insurance systems established to protect the people's medical and health care rights, but there are certain differences in their insured objects, coverage, payment standards and reimbursement ratios.
Legal basis: Article 23 of the "Social Insurance Law of the People's Republic of China" requires employees to participate in employee basic medical insurance, and the employer and employees shall jointly pay basic medical insurance premiums in accordance with national regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other people with flexible employment can participate in the basic medical insurance for employees, and individuals must pay the basic medical insurance premiums in accordance with national regulations.
Article 24 The state establishes and improves a new rural cooperative medical system.
The management measures for the new rural cooperative medical care shall be stipulated by the State Council.
Article 25 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.
Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical insurance and basic medical insurance for urban residents shall be implemented in accordance with national regulations.
Article 27 If an individual who participates in the basic medical insurance for employees reaches the legal retirement age and has paid cumulative contributions for the number of years specified by the state, he will no longer pay basic medical insurance premiums after retirement and will enjoy basic medical insurance benefits in accordance with the regulations of the state;
Yes, you can pay until the number of years specified by the state.
Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.
The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.
Article 30 The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid from the work-related injury insurance fund; (2) Those that should be borne by a third party; (3) Those that should be borne by the public health department
; (4) Seeking medical treatment abroad.
Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first.
After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.
Article 31 Social insurance agencies may sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior based on the needs of management services.
Medical institutions should provide reasonable and necessary medical services to insured persons.
Article 32 If an individual is employed across a coordinating area, his or her basic medical insurance relationship will be transferred with the individual, and the years of payment will be calculated cumulatively.