This means that if the employer fails to pay the medical insurance premium on time, the medical expenses of its retirees at the time of hospitalization can enjoy the same medical insurance benefits as those of retirees from normal payment units.
Recently, Liaocheng Human Resources and Social Security Bureau issued the Notice on Further Adjusting and Perfecting the Policies Related to Basic Medical Insurance (hereinafter referred to as the Notice). In order to improve the basic medical insurance level and ensure the medical needs of the insured, the city will implement the overall medical insurance treatment for retirees in the future, and decouple it from the unit payment.
The relevant person in charge of the medical insurance department in Liaocheng introduced that when the basic medical insurance system was just started in our city from June 5438 to 10, 2000, the employer took 6% of the total wages of its employees as the payment base. Individual employees pay wages at the rate of 2%, commonly known as the "6+2" model. At the same time, the employer pays the basic medical insurance premium for retirees according to 6% of the total pension for retirees.
In 2004, this policy was adjusted: all units that have participated in the municipal basic medical insurance for three years will no longer pay 6% of the basic medical insurance premium for retirees; Units that have been insured for less than three years will continue to pay the basic medical insurance premium for retirees at 6%; The contribution of all employees is increased to 7%, and the individual contribution is still 2%, that is, the "7+2" model.
"In the past, in order to ensure the balance of payments of the medical insurance pooling fund, the policy of linking retirees' medical insurance benefits with unit contributions was implemented in the system design, that is, if the employer defaulted on medical insurance premiums, employees and retirees could not enjoy medical insurance benefits." The person in charge of the medical insurance department said.
In recent years, with the improvement of the coverage rate of insured units and the enhancement of the support capacity of medical insurance pooling funds, it has created conditions for the decoupling of medical insurance benefits for retirees from unit contributions.
According to the "Notice" issued this time, after the insured employees (including self-employed workers and flexible employees) reach the retirement age stipulated by the state and go through the retirement procedures, the accumulated payment of medical insurance will reach the prescribed period, and the units and individuals will no longer pay the basic medical insurance premiums for them and enjoy the basic medical insurance benefits for retirees, and the basic medical insurance benefits will be decoupled from the unit payment.
What should I do if I am below the minimum payment period? According to the notice, the basic medical insurance premium in poor years can be paid in one lump sum according to the regulations, and retirees can enjoy basic medical insurance benefits from the next month. The payment period is determined according to the document [20 1 1] 10 of Chat People's Society, that is, the cumulative payment period of medical insurance premium (including deemed payment period) is 25 years for men and 20 years for women.
It should be noted that after the basic medical insurance benefits for retirees are decoupled from the unit payment, retirees should participate in large-scale medical assistance, and each year, units and individuals pay large-scale medical assistance funds according to the prescribed standards (currently 180 yuan, unit 120 yuan, individual 60 yuan) and enjoy large-scale medical assistance benefits.
In addition, before the issuance of this Notice, the medical insurance fund for retirees will suspend payment of medical expenses during the arrears period, and after the unit makes up the medical insurance premium during the arrears period, the insured person will submit a valid certificate to the medical insurance agency for reimbursement of the suspended medical expenses.
Reporter Xu Jinsong Yue Yaojun