1. What is enterprise supplementary medical insurance? Supplementary medical insurance for enterprises is a form of supplementary medical insurance encouraged by the state and organized or participated by enterprises on the basis of participating in basic medical insurance. It mainly includes enterprise supplementary medical insurance, commercial medical insurance, social mutual assistance and community medical insurance, which is a powerful supplement to basic medical insurance and an important part of multi-level medical security system.
1. Supplementary medical insurance payment ratio Supplementary medical insurance is mainly handled by the unit itself, which can be accrued according to 4% of the total wages of employees of the unit and charged before tax. Units to open a special account for management, earmarking.
According to Article 35 of the Regulations for the Implementation of the Enterprise Income Tax Law of People's Republic of China (PRC), the basic social insurance premiums and housing accumulation funds paid by enterprises for employees in accordance with the scope and standards stipulated by the relevant competent departments of the State Council or the provincial people's government are allowed to be deducted. Supplementary endowment insurance premiums and supplementary medical insurance premiums paid by enterprises for investors or employees are allowed to be deducted within the scope and standards stipulated by the competent departments of finance and taxation of the State Council.
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 stipulates that the supplementary endowment insurance and supplementary medical insurance premiums paid by enterprises for all employees working or employed in their own enterprises in accordance with relevant state policies shall be deducted when calculating taxable income, and 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 Relevant Issues Concerning Supplementary Insurance for Enterprises stipulates that the measures for supplementary medical insurance for enterprises shall 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 included in personal accounts of basic medical insurance, nor shall they 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.
Second, how to use enterprise supplementary medical insurance 1. Proportion of reimbursement for enterprise supplementary medical insurance 1) The principle of reimbursement for enterprise supplementary medical insurance is that the part that is not reimbursed by social security shall be reimbursed from supplementary medical care. For example, the part within outpatient service 1800 and the part outside social security reimbursement 1800, the part within hospitalization 1300 and the part outside social security reimbursement 1300 vary from place to place.
2) How much supplementary medical care an enterprise can reimburse depends on its own choice. For example, in addition to social security reimbursement, outpatient units can choose to reimburse 60%, 80% or even 90%, and hospitalization is the same. You can choose to reimburse 90% and 95% after reimbursement, and choose the proportion when insuring;
3) Supplementary insurance expenses of the enterprise: it depends on the proportion of supplementary insurance reimbursement selected by the enterprise. Outpatient expenses are relatively high, and hospitalization expenses are relatively low, so when many units choose supplementary medical care, the proportion of outpatient services is not so high, so the expenses can be lower. In addition, the cost is related to the number of insured personnel, the average age of personnel and the number of retirees.
4) The insurance premium for supplementary medical care of enterprises is paid once a year, which can be charged to 4% of the salary, but it does not mean that 4% has been paid. If there are changes in personnel, social security will be increased or decreased now, and the supplementary medical personnel can make changes, refunds or increases in the insurance company with the social security change form.
2. Supplementary medical insurance reimbursement instructions Supplementary medical insurance implements the principle of basic medical payment in advance. In a natural year, the insured person will be reimbursed for the medical expenses incurred by outpatient (emergency) consultation or hospitalization due to illness exceeding the deductible line of basic medical insurance. After that, the supplementary medical insurance will reimburse the medical expenses paid by the employees in proportion in basic medical insurance coverage with the medical bills, detailed lists, original diagnosis certificates and other related materials and original documents issued by the medical insurance center. The settlement year is synchronized with the basic medical insurance (according to the natural year).
At the end of the year, if the total amount of medical expenses for outpatient (emergency) consultation does not exceed the basic medical insurance Qifubiaozhun, before the end of the year to the first quarter of the following year, it will be reimbursed by supplementary medical insurance on the basis of the original documents of medical expenses, the bottom side of special medical insurance prescriptions, outpatient medical records, detailed list of expenses and other original materials; The medical expenses incurred in the current year after the reimbursement of supplementary medical insurance shall not be reimbursed.
The insured's hospitalization expenses should be reimbursed to the company within one month after discharge; If you work in a foreign country and participate in the local basic medical insurance, the expenses for outpatient (emergency) consultation and hospitalization will be reimbursed by the local basic medical insurance first, and then the materials will be submitted to the company for supplementary medical reimbursement procedures; If the local basic medical insurance does not reimburse outpatient and emergency expenses, it can be handed over to the company for supplementary medical reimbursement procedures at any time. Basic medical insurance and supplementary medical insurance are not contradictory, but complementary and irreplaceable, and their purpose is to provide medical security for employees. However, both basic medical care and supplementary medical care are limited to social security.
Three. Exceptions to supplementary medical insurance for enterprises-what is not covered 1. Supplementary medical insurance does not reimburse 1) self-funded drugs and purchased drugs outside the provisions of basic medical insurance;
2) The medical expenses are inconsistent with the diagnosis;
3) All medical expenses for outpatient service and hospitalization in medical institutions other than my designated medical institutions;
4) Medical expenses that do not meet or exceed the reimbursement scope and standard of basic medical insurance;
5) All medical expenses caused by traffic accidents, medical accidents and other accidents;
6) All medical expenses caused by drug abuse, fighting and other illegal acts;
7) All medical expenses caused by suicide, self-mutilation and alcoholism;
8) All medical expenses incurred overseas (including Taiwan Province, Hongkong and Macau);
9) All medical expenses for special outpatient service and hospitalization in special wards;
10) All medical expenses for diagnosis and treatment of infertility, all medical expenses for pre-pregnancy examination and all medical expenses for preventive medication;
1 1) medical expenses that should be paid by individuals according to the regulations of the state and this municipality.
Four, the advantages and disadvantages of enterprise supplementary medical care:
1, with wide guarantee and low entry threshold.
As long as they are employees and their families, even if their physical conditions are not so ideal and they cannot buy commercial insurance, they can also underwrite the supplementary medical insurance of enterprises normally.
2. Project management and flexible payment.
Many enterprises' supplementary medical reimbursement is project-based, which is very convenient for reimbursement and claim settlement. Those who should be compensated can be fully compensated, and few are reluctant to pay compensation.
3, welfare nature, no need to bear the premium.
Disadvantages:
It is still impossible to include the self-funded part, which is the biggest disadvantage. Of course, adding a little enterprise group insurance can also fulfill the responsibility.
Verb (abbreviation of verb) How to buy supplementary medical care for enterprises According to the nature and budget of the unit, the supplementary medical insurance to be purchased is different, which is divided into two parts: medical care and pension annuity. When purchasing, we must consider the working environment of the company's employees and see whether the main concern is accident medical insurance or disease protection. Enterprises that participate in various social insurances according to regulations and pay social insurance premiums in full and on time may decide whether to establish supplementary medical insurance.
It is also a customized process for enterprises to purchase supplementary medical care. When purchasing, the human resources department should fully understand the significance of insurance protection to employees. It is best to have experienced brokers (legal persons) to cooperate.
Legal basis:
People's Republic of China (PRC) Social Insurance Law;
Chapter III Basic Medical Insurance
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.