The medical insurance company will transfer the money to the medical insurance card at the end of each month according to a certain proportion between the payment salary and the age, if you personally don't pay or spend every month. Personal account funds will always accumulate, that is, the balance is increasing.
Extended data:
1. Basic medical insurance is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance agency will give certain economic compensation to avoid or reduce the economic risks caused by illness and treatment. 2. The basic medical insurance is one of the most important types of insurance in the social insurance system. Together with the basic old-age insurance, industrial injury insurance, unemployment insurance and maternity insurance, it constitutes a modern social insurance system.
3. Relevant explanations
Basic medical insurance for urban workers
participant
According to the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No.44), all employers in cities and towns, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). ), organs, institutions, social organizations, private non-enterprise units and their employees must participate in the basic medical insurance. That is to say, the units and employees who must participate in the basic medical insurance for urban workers include both government institutions and various urban enterprises, both state-owned and non-state-owned economic units, both enterprises with good benefits and enterprises with difficulties. This is one of the most extensive types of insurance in China's social insurance system.
However, whether township enterprises and their employees, owners of urban individual economic organizations and their employees participate in basic medical insurance shall be determined by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government. This is mainly due to the management of this group of people and the particularity of medical insurance itself. If the basic medical insurance is included, the management ability can't keep up, which may lead to uncontrollable medical expenses and increase the risk of fund overrun.
Do migrant workers participate in basic medical insurance?
The Ministry of Labor and Social Security's Notice on Implementing the Two Regulations, Expanding Social Security Coverage and Strengthening Fund Collection (No.KLOC-0/999 issued by the Ministry of Labor and Social Security) stipulates that farmers' contract workers participate in the social insurance of their units, and social insurance agencies set up individual accounts for their employees. After the termination or rescission of the labor contract, the social insurance agency may issue the personal account of the basic medical insurance to me at one time.
Personal payment
First of all, each overall planning area should determine a personal basic medical insurance contribution rate suitable for the burden level of local employees, which is generally 2% of wage income. Secondly, individuals pay the basic medical insurance premium according to the local individual contribution rate based on wage income. The personal payment base should be based on the statistical caliber of wage income stipulated by the National Bureau of Statistics, that is, all wage income, including all kinds of bonuses, labor income and income in kind, multiplied by the prescribed personal payment rate, is the basic medical insurance premium that I should pay. Third, individual contributions generally do not need to be paid by individuals to social insurance agencies, and are withheld and remitted by the unit from wages.
Payment base
The payment base of basic medical insurance is that the employer takes the total wages of employees stipulated by the state as the payment base, and the employees take their salary income in the previous year as the payment base. If the wage income of employees is higher than 300% of the average wage of local employees, 300% of the average wage of local employees shall be the payment base.
Establish an account
According to the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No.44), the funds injected into individual accounts come from two parts: individual contributions and unit contributions: all individual contributions are credited to individual accounts, and the unit contributions are credited to individual accounts. About 30% of the general unit payment is included in the personal account. However, due to the great difference in the level of medical consumption expenditure of employees of different ages, the age factor should be taken into account when determining the proportion of unit contributions to employee accounts in all co-ordination areas, and the different proportions of different age grades should be determined. Determine the specific proportion of unit contributions included in individual accounts, which shall be determined by the overall planning area according to the payment scope of individual accounts and the age of employees.
The funds injected into the overall fund mainly come from unit contributions. After the unit payment is transferred to the individual account, the rest is the funds of the overall fund.
Account processing
The principal and interest of the employee's personal medical insurance account belong to the employee and can be carried forward and inherited. Therefore, after the death of employees who participate in basic medical insurance, there is still a balance in their personal medical accounts, which can be used as inheritance and inherited by their relatives in accordance with the provisions of the inheritance law. At the same time, his personal medical account number and employee medical social insurance manual were withdrawn and cancelled by medical social insurance institutions.
Designated medical treatment
According to the Notice of the Ministry of Labor and Social Security and other departments on Printing and Distributing the Interim Measures for the Administration of Designated Medical Institutions of Basic Medical Insurance for Urban Employees (No.KLOC-0/999 issued by the Ministry of Labor and Social Security), the insured proposed the intention of selecting designated medical institutions for individual medical treatment within the scope of medical institutions with designated qualifications, which was summarized by the unit to which they belong and submitted to the social insurance agency in the overall planning area. Social insurance agencies shall, according to the choice intention of the insured, co-ordinate the determination of designated medical institutions.
In addition to specialized medical institutions and Chinese medical institutions with designated qualifications, the insured can generally choose 3 to 5 medical institutions of different levels, including at least 1 2 primary medical institutions (including first-class hospitals and various hospitals, outpatient departments, clinics, health centers, infirmary and community health service institutions).
The insured may request to change the designated medical institutions after 1 year, and the social insurance agency in the overall planning area shall handle the change procedures.
compensation
Can enterprise employees reimburse medical expenses if they are too late to go to designated medical institutions for medical treatment due to illness?
According to the Notice of the Ministry of Labor and Social Security and other departments on Printing and Distributing the Interim Measures for the Administration of Designated Medical Institutions of Basic Medical Insurance for Urban Employees (No.KLOC-0/999 issued by the Ministry of Labor and Social Security), the insured can purchase drugs at designated medical institutions or at designated retail pharmacies with prescriptions. In addition to emergency and first aid, the expenses incurred by the insured in non-selected designated medical institutions shall not be paid by the basic medical insurance fund. Therefore, if employees really can't go to the selected hospital for treatment, they will go to a nearby hospital for treatment and hold a hospital emergency certificate, and their medical expenses can be paid by the basic medical insurance fund according to regulations.
Medical treatment period
According to the provisions of the Provisions on Medical Treatment Period for Enterprise Employees Suffering from Illness or Non-work-related Injury issued by the former Ministry of Labor 1994, the medical treatment period refers to the period during which the employees of the employing unit stop working for treatment and rest due to illness or non-work-related injury, and the employing unit may not terminate the labor contract.
The Provisions on the Medical Treatment Period for Enterprise Employees Suffering from Illness or Non-work-related Injury issued by the former Ministry of Labor 1994 mainly stipulates the medical treatment period as follows:
(1) If employees of an enterprise need to stop medical treatment due to illness or non-work-related injuries, they shall be given a medical treatment period of 3 months to 24 months according to their actual working years. If the actual working experience is less than 10 year, it is 3 months if you have worked in this unit for less than 5 years; More than five years is six months. If the actual working experience is more than 10 years, it will be 6 months if you have worked in this unit for less than 5 years; More than 5 years/kloc-0 and less than 9 months; More than 10 years and less than 15 years is 12 months; 15 to 20 years is 18 months; More than 20 years is 24 months.
(2) If the medical treatment period is 3 months, the accumulated sick leave time within 6 months shall be calculated; For 6 months, calculate the accumulated sick leave time within 12 months; 9 months, calculate the accumulated sick leave time within 15 months; 12 months, calculate the accumulated sick leave time within 18 months; 18 months is calculated according to the accumulated sick leave time within 24 months; For 24 months, calculate the accumulated sick leave time within 30 months.
(3) During the medical treatment period, the sick pay, disease relief and medical insurance benefits of enterprise employees shall be implemented according to the provisions of relevant departments.
(IV) If the employees of an enterprise are disabled due to non-work-related injuries and suffer from diseases that are difficult to be treated by doctors or medical institutions, and they can't engage in their original jobs or other jobs arranged by the employing unit after medical treatment, the labor appraisal committee will conduct labor ability appraisal with reference to the Appraisal Standard for Disability Degree of Work-related Injuries and Occupational Diseases (since April 5, 2002) and on the basis of the Appraisal Standard for Disability Degree of Employees Due to Non-work-related Injuries or Diseases (Trial) (issued by the Ministry of Labor and Social Affairs). The labor contract shall not be terminated during the medical treatment period identified as Grade 5 to Grade 10.
(5) If the employees of an enterprise are disabled due to non-work-related injuries or suffering from diseases, and the medical treatment period expires, the labor appraisal committee will conduct the labor ability appraisal with reference to the Appraisal Standard of Disability Degree of Work-related Injuries and Occupational Diseases (since April 5, 2002, based on the Appraisal Standard of Disability Degree of Employees Due to Non-work-related Injuries or Diseases (Trial) (No.8 issued by the Ministry of Labor and Social Affairs [2002]). Those who are recognized as Grade I to Grade IV will quit their posts, terminate their labor relations, go through retirement and resignation procedures and enjoy retirement and resignation benefits.
(6) For those who have not recovered after the expiration of medical treatment, the issue of economic compensation for the termination of the labor contract shall be implemented in accordance with relevant regulations.