The deadline for payment of basic medical insurance for urban and rural residents in 2023 is March 3, 20231. In order to ensure that the vast number of urban and rural residents in our city can enjoy medical security reasonably according to law and prevent them from enjoying medical security benefits due to insurance failure, the general public are requested to carefully check the participation of themselves and their families, and complete the approved payment of basic medical insurance for urban and rural residents before March 3, 2023.

For the first time, apply for insurance registration in the township or sub-district office where the household registration or residence permit is located. Students and kindergarten children are registered by their schools or kindergartens. The renewal personnel can pay directly by mobile phone without applying for insurance registration.

The scope of payment of medical insurance:

For employees who participate in comprehensive medical insurance, 90% of the basic medical expenses during hospitalization are paid by the basic medical insurance pooling fund, and the individual pays 10%. For retirees who participate in comprehensive medical insurance, 95% of the basic medical expenses during hospitalization are paid by the basic medical insurance pooling fund and 5% by individuals, unless otherwise stipulated in these Measures.

The basic outpatient medical expenses of the insured person of comprehensive medical insurance and the expenses of the grandson's drugs and medical treatment items using the local supplementary medical insurance drug list in outpatient service shall be paid by the personal account. Personal account is insufficient to pay, outpatient basic medical expenses by the basic medical insurance fund to pay 70%, individuals pay 30%. Brief introduction of 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 for workers within the scope of protection when they are sick. 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. Medical insurance has the characteristics of "low level and wide coverage", and the payment is based on the expenses that most units and individuals can afford at a low level, covering all units and employees in cities and towns.

The specific reimbursement process of medical insurance may vary from place to place, and the general process is as follows:

1. If you are hospitalized, you can submit the social security card and other related documents to the relevant departments of the hospital within three days of hospitalization, and you can directly submit the reimbursement and settlement to the relevant offices when you leave the hospital;

2. Hospitalization due to trauma. It is also necessary to go through the relevant formalities at the hospital medical insurance office with valid documents such as ID card and social security card within three days. Those who meet the medical insurance can go through the settlement procedures directly when they leave the hospital;

3. In case of accidental injury in the outpatient department, you need to bring your ID card, outpatient medical record invoice and other documents after treatment, and then go to the medical insurance department for reimbursement after verification.

Medical insurance benefits include the following main contents:

1, medical

Employees enjoy medical insurance benefits, except those who have completely lost their ability to work, and are limited to the prescribed medical treatment period. The length of the medical treatment period is determined according to the continuous length of service of the employees and the length of service of the unit, and the shortest is not less than 3 months, and the longest is generally not more than 24 months; Suffering from an incurable disease, the medical treatment period may be appropriately extended upon the application of a medical institution and the approval of the labor administrative department, but the longest period shall not exceed 6 months;

2. Sickness benefits

Sick pay is also called sick pay. If an employee suffers from illness or non-work-related injury and stops working for more than 1 month, his salary will be stopped, and the employer will pay a certain percentage of his salary according to his length of service, which is not less than 80% of the local minimum wage;

3. Medical treatment

Workers can generally choose to seek medical treatment in designated hospitals that have signed medical insurance contracts with social insurance agencies. Insurance benefits mainly include: drug expenses within the prescribed scope, prescribed examination expenses and treatment expenses, and prescribed standard hospitalization expenses. Among them, employees' personal accounts are used to pay small medical expenses, and social pooling funds are used to pay large medical expenses. In addition, when employees support their relatives for treatment, they generally only give a certain proportion (generally 50%) of medical expenses for certain items (such as medicine expenses and surgery expenses).

To sum up, the deadline for medical insurance payment in 2023 is March 3, 20231.

Legal basis:

Article 27 of People's Republic of China (PRC) Social Insurance Law

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 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

second

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance. To ensure citizens' right to receive material assistance from the state and society in accordance with the law in cases of old age, illness, work injury, unemployment and simple education.