The medical insurance payment base is the base calculated by medical insurance participants to pay medical insurance fees according to a certain proportion.

social security payment base is the payment standard of social insurance payment, and the payment amount is verified according to the base and coefficient. The social security payment base is 6% to 3% of the average social wage. For example, the average social wage is 1 yuan, and the payment base can be 6 yuan to 3, yuan.

medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. Therefore, the medical insurance system is usually legislated and enforced by the state, and a fund system is established. The expenses are paid by both the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the workers.

medical insurance, like other types of insurance, is to collect medical insurance premiums from people threatened by diseases in advance by contract and establish a medical insurance fund; When the insured falls ill and goes to a medical institution to see a doctor, the medical insurance institution will give him some economic compensation. Therefore, medical insurance also has two major functions of insurance, risk transfer and compensation transfer.

According to the basic requirements for the payment of basic medical insurance benefits in China, the insured must generally meet the following conditions when he goes to the medical insurance institution to reimburse the medical expenses incurred by his own medical treatment:

1. The insured must go to the designated medical institution of basic medical insurance to seek medical treatment and purchase medicines, or purchase medicines from the designated retail pharmacy determined by the social insurance institution with a medical prescription issued by a doctor in a designated hospital;

2. The medical expenses incurred by the insured in the process of seeing a doctor must conform to the scope and payment standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards, before they can be paid by the basic medical insurance fund according to regulations;

3. among the medical expenses that the insured meets the payment scope of the basic medical insurance, the part above the threshold and below the maximum payment limit of the social medical pooling fund shall be paid by the social medical pooling fund in a unified proportion.

legal basis

social insurance law of the people's Republic of China

article 23 employees shall participate in basic medical insurance for employees, and the employer and employees shall pay the basic medical insurance premiums in accordance with the state regulations.

individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employing unit and other flexible employees can participate in the basic medical insurance for employees, and individuals will pay the basic medical insurance premium according to state regulations.