1. If the interruption is caused by the employer, the medical expenses incurred by the insured during the interruption shall be borne by the employer, except for the part that should be borne by the individual;
2. If medical insurance is interrupted for personal reasons, the medical expenses incurred during the interruption shall be borne by the individual. You can't enjoy hospitalization reimbursement after two months of broken medical insurance.
You can enjoy medical insurance benefits within 180 days after the payment expires. The interruption does not affect the cumulative payment period, but it takes 180 days to enjoy the medical reimbursement policy again. Generally speaking, once employees' medical insurance is broken, they will no longer enjoy medical insurance benefits from the month after it is broken. If the medical insurance premium and interest are paid within three months, the medical insurance benefits will be restored from the next month of payment, but the proportion of individual pays will increase in this settlement year.
For ourselves, in fact, it is very important and crucial to continue to pay medical insurance. After all, it is directly related to whether we can enjoy medical insurance reimbursement normally. For example, if a new work unit is not found, even if a new work unit is found, some work units may not pay social security during the probation period. If such a problem arises, it is actually more reasonable for us to participate in insurance according to flexible employment.
In addition, participate in insurance according to flexible employment. You can effectively accumulate your own payment years, including your employee pension insurance and employee medical insurance, which can be calculated normally and effectively. Then your medical insurance will have a continuous payment, so once you see a doctor, there will be no problems and influences on yourself. Therefore, in order to maintain the normal reimbursement of medical insurance, we must continue to pay medical insurance.
Medical insurance interruption payment follow-up insurance:
1, the unit interrupts payment (including failure to pay in full and on time), the medical insurance is suspended and credited to the personal account of the employees of the unit, and the account is blocked. The medical expenses incurred during the suspension of participation will not be reimbursed, and the self-raised funds of the unit will be reimbursed according to the medical insurance policy;
2. If the payment is suspended for renewal within one year, the hospitalization expenses incurred from the effective date of renewal can be reimbursed, and the medical insurance fund that incurred hospitalization expenses before renewal will not pay; If the payment is suspended for more than one year, there is a six-month exemption period.
Consequences of medical insurance interruption and non-payment: Newly insured employees (including those who re-participate after interruption of payment 1 year or more) shall participate in basic medical insurance according to law, and enjoy basic medical insurance benefits according to regulations after continuous payment of 1 year (excluding payment years); Over six months but less than one year, according to 50%; If it is less than six months, it will not be paid. If there is no intermittent payment, or if the intermittent payment does not exceed one year, the payment in the month of hospitalization will not affect the medical insurance reimbursement.
legal ground
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.