1, different payment names: overall payment is called overall fund, and individual payment is called personal account;
2. The payment amount is different: the overall payment has the highest payment limit, and the individual payment has no limit;
3. The scope of payment is different: the overall payment only pays medical expenses, operation expenses, nursing expenses, basic examination fees, etc. The insured employee's; Personal payment needs to pay all expenses except overall payment;
4. Everyone is different: the owners of the overall fund are all insured; The owner of the personal account is the insured himself;
5. The composition of funds is different: pooling funds to achieve fund benefits comes from the medical insurance fees paid by various units to employees; Personal account funds mainly come from the expenses paid by the insured and part of the expenses paid by the unit;
6. The scope of reimbursement is different: medical insurance pays large expenses such as reimbursement of hospitalization expenses, special outpatient expenses, partial chemotherapy and dialysis treatment expenses; Personal accounts are used to buy medicines, outpatient expenses, and small expenses that need to be borne by individuals after overall payment;
7. Different ways of use: the personal account of employee pension insurance can be used for personal consumption after retirement, while the overall account is used for monthly pension and funeral subsidies and pensions paid to survivors after the insurer dies.
Matters needing attention for overall fund payment and personal account payment are as follows:
1, the overall fund refers to the social insurance project fund * * * economy; Personal account is used to record the part paid by the insured and the part transferred from the unit, as well as the interest of the above two parts;
2, the overall fund in the medical insurance designated hospitals for reimbursement; Personal accounts are mainly used to buy medicines in designated pharmacies of medical insurance and pay medical expenses outside the overall fund;
3. There are restrictions on the reimbursement ratio of the overall fund; There is no reimbursement ratio limit for personal accounts;
4. The payment scope of the overall fund includes hospitalization expenses, special outpatient expenses, part of chemotherapy and dialysis treatment expenses and other large expenses; The scope of personal account payment includes small expenses that need to be paid by individuals outside the overall fund, such as drug purchase, outpatient expenses and medical expenses;
5. Personal accounts can be used to pay small expenses such as outpatient fees and drug purchase fees in pharmacies, while the overall fund usually has the highest payment limit;
6. The overall fund shall be reimbursed in proportion, and the individual account shall be reimbursed at its own expense first, and then by invoices and other materials;
7. The funds of the overall fund come from the medical insurance fees paid by enterprises and the medical insurance fees for urban residents; Personal account funds come from the amount paid by individual employees in employee medical insurance.
To sum up, the above is the matters needing attention in coordinating fund payment and personal account payment. You can consult relevant departments if you have any questions.
Legal basis:
Article 11 of the Social Insurance Law of People's Republic of China (PRC)
The basic old-age insurance combines social pooling with individual accounts.
The basic old-age insurance fund consists of employers, individual contributions and government subsidies. Article 12 The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of employees stipulated by the state and record it in the basic old-age insurance pooling fund.
Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual accounts respectively. Fifteenth basic pension consists of overall pension and individual account pension.
The basic pension is determined according to factors such as individual cumulative payment years, payment wages, average salary of local employees, personal account amount, average life expectancy of urban population, etc.