medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs protection for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account and the other part is used to establish the overall fund. When seeing a doctor with a patient, doctors often consider the patient's medical insurance. Here is the basic knowledge of social medical insurance.

composition of social overall medical insurance: the payment base is m: employee's wage income+allowance. The unit pays 8% m every year; Individual employees pay 2% m every year;

the company pays 8%-6.6% to 7% into the overall account (1% to 1.4% into the personal account)-hospitalization expenses;

2% of individual payment-2% goes into individual account (plus 1% to 1.4% of unit payment)-outpatient fee.

suppose: a 3-year-old employee of a company earns 2, yuan a year, and after handling social medical insurance, the company pays 1,6 yuan a year; Employees themselves pay 4 yuan every year.

The personal account consists of two parts: 4 yuan paid by the individual+1% of the 2, yuan paid by the company, that is, 2 yuan and 6 yuan in 1,6 yuan;

(The percentage is 1% under 35 years old according to regulations; More than 35 is 1.4%)

Overall account: the remaining 7% of the 8% paid by the unit is 1,4 yuan.

note: hospitalization expenses are reimbursed from the overall account, and the amount is the same for everyone; Outpatient expenses are deducted from personal account (i.e. medical insurance card), which is different for each person. Features have the characteristics of "low level and wide coverage". The payment is based on the expenses that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees of different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "both parties bear the burden, and the unified account is combined"; Based on the principle of "balance income and expenditure". Social security, the full name of social insurance, refers to a social insurance or security mechanism to help citizens face certain social risks, such as unemployment, illness, accidents, aging and death, or to protect basic living resources, such as education and medical care. Modern social insurance was founded by otto von bismarck in the 19th century. Basic Introduction For employees, social security refers to "five insurances and one gold", specifically, pension insurance, medical insurance, unemployment insurance, industrial injury insurance and maternity insurance; One gold: housing accumulation fund. Relative proportion "housing accumulation fund": the proportion borne by specific units and individuals is 5% each, which is calculated according to the average annual salary of individuals. The state stipulates that the housing accumulation fund shall not be less than 1% of the salary, and the units with good benefits may be higher, and the employees and units shall bear 5% respectively.

"five risks": according to the wages of employees, the proportion of units and individuals is generally: pension insurance units bear 15%, individuals bear 8%; 6% for medical insurance units and 2% for individuals; 1% for the unemployment insurance unit and 1% for the individual; 1% of maternity insurance shall be borne by the unit; .8% of industrial injury insurance is also borne by the unit, and individual employees do not bear maternity and industrial injury insurance. Basic characteristics Five characteristics of social insurance:

1. The objective basis of social insurance is the risks existing in the labor field, and the object of insurance is the personal of the workers;

2. The subject of social insurance is specific. Including workers (including their relatives) and employers;

3. Social insurance is compulsory;

4. The purpose of social insurance is to maintain the reproduction of labor;

5. The insurance fund comes from the payment and financial support of employers and workers.

the scope of insurance is limited to employees, excluding other social members. The scope of insurance is limited to all kinds of risks in labor risks, excluding other risks such as property and economy. (Some companies do not calculate the five insurances and one gold according to the actual salary of employees, but set a different base to calculate and pay.) Project Content A Endowment insurance

Endowment insurance is a social insurance system in which workers get some financial compensation, material help and services from the government and society after they reach the legal retirement age.

State-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises and other urban enterprises and their employees, and institutions and their employees that implement enterprise management must participate in the basic old-age insurance.

The new participating units (referring to all kinds of enterprises) have a unit payment rate of 1% and an individual payment rate of 8%. Individual industrial and commercial households, their employees, flexible employees and other types of individuals who participate in the insurance are subject to different rates according to the payment period. Individual workers who participate in the basic old-age insurance, the payment base can be high or low within the prescribed scope, and more benefits can be gained from more contributions. To receive a monthly pension, employees must reach the statutory retirement age and have gone through retirement procedures; The unit and individual have participated in the endowment insurance according to law and fulfilled the obligation to pay the endowment insurance; Individual contributions have been paid for at least 15 years.

At present, the legal retirement age of enterprise employees in China is: male employees are 6 years old; Female cadres engaged in management and scientific research are 55 years old and female employees are 5 years old. The basic pension consists of basic pension and personal account pension. If the employee reaches the statutory retirement age and the individual contribution has reached 15 years, the monthly standard of basic pension is 2% of the average monthly salary of employees in the province (autonomous region or municipality directly under the Central Government) or city (prefecture) in the previous year. Personal account pension is paid by personal account fund, and the monthly payment standard is divided by 12 according to the amount stored in my account. After the individual account fund is used up, it will be paid by the social pooling fund.

B medical insurance

the basic medical insurance system for urban workers is a social insurance system established according to the affordability of finance, enterprises and individuals to ensure the basic medical needs of workers.

all employers, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises and private enterprises, etc.), government agencies, institutions, social organizations, private non-enterprise units and their employees, must participate in the basic medical insurance. The basic medical insurance fund for urban employees consists of the social pooling fund of basic medical insurance and individual accounts. The basic medical insurance premium consists of the employer and the employee's personal account. The basic medical insurance premium shall be paid by both the employer and the employee, of which the employer shall pay 6% and the individual shall pay 2%. Part of the medical insurance premium paid by the employer is used to establish the basic medical insurance social pooling fund, which is mainly used to pay for the hospitalization and special chronic disease outpatient service, rescue and first aid of the insured employees. The basic medical insurance Qifubiaozhun above, the highest payment limit below in accordance with the provisions of the medical expenses, which individuals should also be required to bear a certain proportion of the cost. Personal account funds are mainly used to pay the insured's expenses for medical treatment and drug purchase in designated medical institutions and retail pharmacies. The part of personal account funds used up or insufficient is paid by the insured in cash, and the personal account can be carried forward and inherited according to law. Insured employees are hospitalized due to illness, first pay the hospitalization deductible, and then enter the overall fund and individual employees to pay for the period.

units and individuals participating in basic medical insurance must participate in large medical insurance at the same time, and pay the basic medical insurance premium and large medical insurance premium in full and on time according to the regulations before they can enjoy the relevant treatment of medical insurance.

C industrial injury insurance

industrial injury insurance is also called occupational injury insurance. The state and society shall provide necessary material assistance to the injured, disabled and dependent relatives of the deceased after the workers are accidentally injured due to work reasons or occupational diseases caused by exposure to occupational hazards such as dust, radiation and toxic substances.

The work-related injury insurance premium is paid by the employer, and the collection rate of work-related injury insurance premium for industries with high accident rate is higher than the general standard. On the one hand, it is to ensure that the work-related injury insurance fund can fully pay the work-related injury insurance benefits for workers in these industries when they have work-related injuries; On the other hand, through high-rate collection, enterprises have a sense of risk and strengthen work-related injury prevention to reduce the casualty rate.

if an employee is hospitalized for a work-related injury after being insured for work-related injury, the unit to which he belongs will give him a food subsidy for hospitalization according to 7% of the food subsidy standard for his business trip; If the medical institution issues a certificate and reports it to the agency for approval, and the injured worker goes to the outside of the overall planning area for medical treatment, the required transportation, accommodation and expenses shall be reimbursed by the unit according to the standard of the employee's business trip. In addition, due to the needs of daily life or employment, workers with work-related injuries can install artificial limbs, orthotics, artificial eyes, dentures and wheelchairs and other assistive devices, and the required expenses are paid from the work-related injury insurance fund according to the standards stipulated by the state. Work-related injury medical expenses for the insured workers with work-related injuries, disability allowance for workers with work-related injuries from Grade I to Grade IV, one-time disability allowance, living care fee, funeral allowance, pension for dependent relatives, assistive devices, work-related injury rehabilitation fee, and labor ability appraisal fee shall be paid from the work-related injury insurance fund.

D unemployment insurance

unemployment insurance is a system that is enforced by the state through legislation, and funds are set up by the society to provide material assistance to workers who have temporarily interrupted their livelihood due to unemployment.

all kinds of enterprises and their employees, public institutions and their employees, social organizations and their employees, private non-enterprise units and their employees, and employees with whom state organs have established labor contracts should apply for unemployment insurance. The unemployment insurance fund is mainly used to guarantee the basic livelihood of the unemployed. Urban enterprises, institutions, social organizations and private non-enterprise units pay unemployment insurance premiums at 2% of their total wages, and their employees pay unemployment insurance premiums at 1% of their wages. Units without fixed wages pay unemployment insurance premiums based on the average social wage in the last year in the overall planning area. The unit employs contract workers of farmers and herdsmen who do not pay unemployment insurance premiums.

At present, the scope of employees participating in unemployment insurance in China includes: on-the-job employees; Off-the-job employees such as unpaid leave, long vacation, loan and external employment, and internal retirement; Laid-off workers entering the re-employment service center; Other employees who have established labor relations with their own units (including temporary workers and rural workers who have established labor relations). Unemployed persons in urban enterprises and institutions can enjoy unemployment insurance benefits if they meet the following conditions in accordance with relevant regulations: they have participated in unemployment insurance in accordance with regulations, and their units and I have fulfilled their payment obligations for one year in accordance with regulations, followed by those who have not interrupted their employment because of their own wishes, and those who have registered for unemployment and have job requirements.

E maternity insurance

maternity insurance is aimed at the physiological characteristics of childbearing behavior. According to the law, when working women temporarily suspend their work and lose their normal income due to childbirth, they are provided with material help by the state or society.

Maternity insurance benefits include maternity allowance and maternity medical services. The maternity insurance fund consists of the maternity insurance premium paid by the employer, its interest and overdue fine. Maternity allowance for female employees during maternity leave, medical expenses incurred during childbirth, family planning operation expenses for employees and other expenses related to maternity insurance stipulated by the state should all be paid from maternity insurance fund.

all employers (including various organs, social organizations, enterprises, institutions and private non-enterprise units) and their employees must participate in maternity insurance. Maternity insurance is paid by the employer, and individual employees do not pay maternity insurance premiums. Maternity insurance premium shall be paid by the employer according to .7% of the total wages of employees in the previous year. Employees who enjoy maternity insurance benefits must meet the following three conditions: the employer has participated in maternity insurance for more than 6 months and paid maternity insurance premiums in full and on time; The relevant provisions of the family planning policy give birth or abortion; Designated medical service institutions in urban maternity insurance in this city, or approved to be transferred to obstetric medical service institutions for production or abortion (including natural abortion and induced abortion). Payment process 1. Social insurance handling process

The relevant procedures for endowment insurance are as follows:

All kinds of enterprises (including state-owned enterprises, collectively-owned enterprises, joint-stock enterprises, joint-stock cooperative enterprises, foreign-invested enterprises, private enterprises, etc.) and enterprises with enterprise management (employees' wages and retirement benefits are implemented according to enterprise standards) should go to the tax payment place (non-tax-paying units are located in the unit address area) according to the principle of territorial management

The newly established unit shall enter the registration formalities within 1 month from the date of approval of the establishment of the unit. Insured units must handle social insurance procedures for all personnel (except retirees employed) who have factual labor relations with them.

1. Forms and attached materials to be filled in:

1. Social insurance registration form and list of changes in on-the-job employees (in duplicate) and collect them from the social insurance agencies under their jurisdiction.

The relevant documents are as follows:

(1) Business license (copy) of the enterprise or other documents approved for practice or establishment;

(2) Organization code certificate of the People's Republic of China;

(3) local tax registration certificate;

(4) If the relevant documents can't clearly identify the nature of the company, the private enterprise should submit relevant materials that can prove its private nature (such as the certificate of the industrial and commercial department, the national tax registration certificate, the capital verification report, etc.).

(5) The public institution shall be attached with the approval documents on the establishment of the public institution.

(6) The letter of authorization from the head office or head office should be attached to the office in China.

attached information: a copy of the ID card of the newly insured employee (the employee whose household registration is not in this city should also provide a copy of the household registration or temporary residence permit)

Both the original and a copy of the above documents are required, and they should be handled at the local social security agency.

2. Notes on filling in the form:

1. Social insurance registration form

"Tax number": the column number of "Tax word is 42137483492" in the tax registration certificate.

"industrial and commercial registration license information": units (such as various enterprises) that need industrial and commercial registration and obtain industrial and commercial licenses should fill in this column, and do not fill in the "information on approval of establishment" column.

"information on approval of establishment": units (such as institutions, institutions, social organizations, etc.) established without industrial and commercial registration should fill in this column, and the "information on industrial and commercial registration license" should not be filled in.

"the person in charge of the payment unit": fill in the contact person, department and telephone number of the social insurance unit who is specifically responsible for this work.

"company type" and "affiliation": according to the company type and affiliation of the insured company, fill in the corresponding code in "Description" at the bottom of the comparison table.

"deposit bank": the clearing bank number of the deposit bank must be filled in.

2. Details of the increase or decrease of on-the-job employees:

Name, gender, date of birth and personal account (ID number) should be filled in strictly according to the information in the ID card.

"personal number": the "renewal" and "transfer-in" personnel need to provide their original personal number, and fill in this form.