1, overall payment of medical insurance: the funds in the overall account are used to pay the related medical expenses of the insured, and the insured does not need to pay separately;
2. Individual pays: it belongs to the scope of medical insurance fund payment, and some drugs, articles and materials need to be paid by the insured in advance;
3. Personal expenses: drugs and articles beyond the scope of medical insurance fund shall be paid in full by the insured.
Qifubiaozhun for the first hospitalization of employees in the settlement year is determined according to different levels of hospitals. For tertiary hospitals, the threshold for employees (including flexible employees and those receiving unemployment insurance benefits) is 800 yuan. Every time the insured is hospitalized, the medical expenses within the Qifubiaozhun shall be borne by the individual, and can also be offset by the balance of the personal account in the previous year. In the settlement year, after the expenses incurred in each hospitalization are calculated according to the regulations, the rest will directly enter the settlement part of the corresponding medical insurance fund according to the accumulated expenses of specific items of hospitalization and outpatient service in that year: the part below 40,000 yuan will be settled according to the proportion of 90% of employees and 95% of retirees; The part exceeding 40,000 yuan shall be paid at a unified rate of 95%.
Legal basis: Article 2 of People's Republic of China (PRC) Social Insurance Law.
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 get material help from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
essay
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.