There are two accounts in medical insurance, namely, the overall medical insurance account and the personal medical insurance account. According to the latest personal account reform of medical insurance, the part originally shared by the unit is no longer included in the personal account of medical insurance, but directly included in the overall account of medical insurance. The simple understanding is that the funds paid by individual employees are in the medical insurance personal account, that is, the medical insurance card, and the funds paid by the unit are in the medical insurance overall account.
Medical insurance planning includes the following aspects:
1. fund management: the medical insurance coordinator is responsible for managing the medical insurance fund to ensure the rationality and standardization of fund raising, distribution and use. This includes the source of income of the fund, the setting of payment ratio and the investment management of the fund.
2. Medical service management: the medical insurance coordinator is responsible for formulating the payment standard for medical services, selecting and managing designated medical institutions, and ensuring that medical insurance participants receive reasonable and effective medical services;
3. Controlling medical expenses: Medical insurance co-ordination controls the growth of medical expenses and ensures the sustainability of medical insurance funds by setting the payment limit of medical expenses, formulating the drug list and negotiating the price of medical services.
4. Overall planning scope: medical insurance determines the coverage and treatment standard of medical insurance as a whole, coordinates the medical insurance policies among different regions and groups, and ensures the fairness and consistency of the medical insurance system.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 27
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 60
The employing unit shall declare itself and pay social insurance premiums in full and on time, and shall not postpone or reduce the payment except for legal reasons such as force majeure. The social insurance premiums that employees should pay shall be withheld and remitted by the employer, and the employer shall inform me of the details of paying social insurance premiums on a monthly basis.
Individual industrial and commercial households without employees, part-time employees who have not participated in social insurance in the employing units and other flexible employees can pay social insurance premiums directly to the social insurance premium collection agencies.