Unit contribution ratio: due to the different economic development in different places, the proportion of medical insurance paid by units is also different, with a national average of 7.5% (in some places, it is 9%, even 10%, and in some places it is still kept at a minimum of 6%);
Individual contribution ratio: the national employee individual contribution ratio is set at 2%.
The money paid into the medical insurance card is divided into two parts, one into the overall account and the other into the personal account.
medical insurance
Medical insurance refers to social medical insurance. It is a social insurance system for the basic medical needs of workers according to laws and regulations when they are sick.
20 16 65438+ 10/2 the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents" to promote the integration of medical insurance for urban residents and the new rural cooperative medical system, and gradually establish a unified national medical insurance system for urban and rural residents. [ 1]
On February 20th, 2065438+0616, Ministry of Human Resources and Social Security held a video conference on the nationwide networking of basic medical insurance and direct settlement of medical treatment in different places, and signed letters of responsibility with the first batch of 22 provinces including Beijing, which applied for nationwide networking of basic medical insurance and direct settlement of medical treatment in different places, marking the formal implementation stage of direct settlement of medical treatment in different places. [2]
According to the statistical bulletin of June 20021year, the number of people participating in the national basic medical insurance in 2020 is 136 13 1 10,000, and the participation rate is stable at over 95%.
Characteristics of medical insurance
Personal account, social security card, settlement process of medical insurance system, reimbursement of medical insurance for college students, historical evolution of medical reform, and nationwide networking of smoking cessation.
brief introduction
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.
The composition of social overall medical insurance: the base of payment is m: wage income of employees+allowance. The unit pays 8% m every year; Individual employees pay 2% m every year;
The unit pays 8% m: 6.6% m to 7%M into the overall account (1%M to 1.4%M into the personal account)-hospitalization expenses; 2%M: 2%M of the salary paid by the individual goes into the personal account (plus the unit payment 1%M to 1.4% M)- outpatient expenses.
Note: hospitalization expenses are reimbursed from the overall account, and the amount is the same for everyone; Outpatient expenses are deducted from personal accounts (that is, medical insurance cards), and everyone is different.
On May 2, 20 17, it was reported that Ministry of Human Resources and Social Security and the Ministry of Finance issued a notice requesting that the per capita medical insurance subsidy standard for residents at all levels should be increased to 30 yuan on the basis of 20 16 in 20 17, and the per capita medical insurance subsidy should reach 450 yuan every year. In 20 17, the per capita personal payment standard of medical insurance for urban and rural residents was raised in 30 yuan on the basis of 20 16, and the per capita reached 480 yuan every year. [3]
Characteristics of medical insurance
With the characteristics of "low level and wide coverage", the payment is based on the cost that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees of different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "the burden of both parties and the combination of unified accounts"; Based on the principle of "balance of payments".
medical insurance
superiority
Enjoy treatment according to uniform standards. The same access conditions, the same fees, the same treatment, there is no difference between high and low. The employee's outpatient expenses can be deducted from his personal account and paid by the employee after deduction. The hospitalization expenses of employees shall be reimbursed in proportion: 1 1,000 yuan, and 86% of the expenses shall be reimbursed by tertiary hospitals; 65,438+0,000 to 20,000 yuan, and 88% of the expenses are reimbursed by tertiary hospitals; 20,000 to 40,000 yuan, and 92% of the expenses are reimbursed by tertiary hospitals. If employees have not been sick for several years in a row, personal account funds can be accumulated.
medical insurance
disadvantage?
There is a basic deductible line for each hospitalization, namely, the first-level hospital 500 yuan, the second-level hospital 750 yuan, and the third-level hospital 1, 000 yuan. These expenses need to be borne by employees themselves. Class A drugs and Class B drugs are reimbursed in proportion, and imported drugs are not reimbursed. If the amount exceeds 40 thousand, you have to pay for it yourself
individual account
Personal account of medical insurance is a special account established according to the basic medical insurance policy, which is specially used to store the medical insurance premiums paid by the insured and the funds allocated by the employer according to a certain proportion, and record the medical consumption. The funds in the personal account are used to pay for the out-of-pocket part of medical treatment and medicine purchase.
social security card
Social security card is an electronic information card that medical insurance agencies handle for the insured to seek medical treatment and purchase medicines, and is used to verify identity, record and store personal account funds and usage. With my social security card, the insured can seek medical treatment at any designated medical institution in this city or purchase medicines at designated retail pharmacies.
medical insurance
Medical insurance system
From 65438 to 0988, China government began to reform the free medical system of government agencies and the labor insurance medical system of state-owned enterprises. From 65438 to 0998, the China Municipal Government promulgated the Decision on Establishing the Basic Medical Insurance System for Urban Employees, and began to establish the basic medical insurance system for urban employees throughout the country.
The basic medical insurance system in China adopts the mode of combining social pooling with individual accounts. The basic medical insurance fund shall, in principle, implement municipal co-ordination. The basic medical insurance covers all employers and their employees in cities and towns; All enterprises, state administrative organs, institutions and other units and their employees must fulfill the obligation to pay the basic medical insurance premium. At present, the employer's contribution ratio is about 6% of the total salary, and the individual contribution ratio is 2% of my salary. Part of the basic medical insurance premium paid by the unit is used to establish the overall fund, and part of it is included in the personal account; The basic medical insurance premiums paid by individuals are included in personal accounts. Pooling funds and individual accounts bear different responsibilities for payment of medical expenses. The overall fund is mainly used to pay for the hospitalization and outpatient treatment of some chronic diseases, and the overall fund has a minimum payment standard and a maximum payment limit; Personal accounts are mainly used to pay for general outpatient expenses.
In order to ensure that the insured employees enjoy basic medical services and effectively control the excessive growth of medical expenses, the China Municipal Government has strengthened the management of medical services, formulated the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards, provided qualified medical institutions and pharmacies with basic medical insurance services, and allowed the insured employees to choose independently. In line with the reform of the basic medical insurance system, the state has also promoted the reform of medical institutions and drug production and circulation systems. By establishing the competition mechanism between medical institutions and the market operation mechanism of drug production and circulation, we will strive to achieve the goal of "providing better medical services at lower cost".
In addition to the basic medical insurance, large medical expenses mutual aid system is generally established in all localities to solve the medical expenses above the maximum payment limit of social pooling funds. The state has established a medical subsidy system for civil servants. Conditional enterprises can establish supplementary medical insurance for employees. The state will also gradually establish a social medical assistance system to provide basic medical security for the poor.
The reform of the basic medical insurance system in China has been steadily advanced, and the coverage of basic medical insurance has been continuously expanded. By the end of 20001,97% of cities and towns in China had started the reform of basic medical insurance, and 76.29 million employees had participated in the basic medical insurance. In addition, free medical care and other forms of medical security system have covered 1 100 million urban population, and China government is gradually bringing these people into the basic medical insurance system.
20 16 65438+ 10/2 the State Council issued "opinions on integrating the basic medical insurance system for urban and rural residents" to promote the integration of medical insurance for urban residents and the new rural cooperative medical system, and gradually establish a unified national medical insurance system for urban and rural residents. [ 1]
2065438+June 2008, Jiangxi Provincial Department of Human Resources and Social Security issued the catalogue code of Chinese herbal pieces of basic medical insurance, industrial injury insurance and maternity insurance in Jiangxi Province. 875 kinds of Chinese herbal pieces were uniformly included in the scope of medical insurance payment, of which 8 16 kinds (accounting for 93.26%) were included in Class A reimbursement, and there was no proportion of individual payment in advance.