1. Pay by service item.
Payment by service item is a settlement method that medical insurance agencies agree to pay fees to hospitals according to service items, which belongs to post-payment system.
2. Total prepayment system
The total budget of the designated medical institutions for one year (or the total budget for the first quarter) shall be determined by the medical insurance institutions after consultation with the designated medical institutions. When medical insurance institutions pay the medical expenses of designated medical institutions, regardless of the actual medical expenses, they use this budget as the maximum payment limit to control the payment, and the designated medical institutions must provide the prescribed medical services to all insured persons within the insurance scope.
3. Pay by service unit
Medical insurance institutions pay the daily expenses of inpatients according to the pre-determined hospitalization expenses standards, and pay the expenses of outpatients according to the various expenses standards stipulated in the budget. All patients in the same hospital pay the same and fixed daily hospitalization or outpatient expenses, regardless of the actual cost of each patient's daily or each treatment.
4. Per capita wage
Also known as average fixed payment, the medical insurance institution first sets the reimbursement standard for each outpatient or inpatient, and then the medical insurance institution pays the medical expenses to the hospital according to the actual service number (outpatient and inpatient) provided by the hospital. This payment method is also a prepayment system, and the income of the hospital increases with the increase of the number of patients.
5, according to the disease charges
Also known as the prepayment system based on the disease quota, according to the international disease classification standard, the diseases of inpatients are divided into several groups according to the diagnosis, and the different levels are priced separately, and they are paid to the hospital in one lump sum at this price.
Second, how many years should medical insurance be paid?
The state stipulates that the payment period is 25 years for men and 20 years for women.
Before 1 and February 3, 20031,if the insured reaches the continuous length of service stipulated by the state or has worked for more than 35 years, and the actual payment period of medical insurance premium reaches 10 years, he will no longer pay medical insurance premium and enjoy medical insurance benefits for life.
2.65438+Before February 3, 20031,if the insured has met the national requirements for continuous service or has worked for 30 years but less than 35 years, he will actually pay the medical insurance premium in 12, no longer pay the medical insurance premium, and enjoy the medical insurance benefits for life.
3.65438+Before Feb. 3, 20031,if the insured has met the national requirements for continuous service or has worked for less than 30 years, the actual payment period of medical insurance premium will be increased correspondingly on the basis of the 2nd anniversary of/kloc-0, and it will be regarded as the actual payment period of the insured (the longest is not more than 30 years). If my actual payment period has expired and reached the statutory retirement age, I will not pay medical insurance premiums; If the actual payment period has not reached the statutory retirement age, I will continue to pay until I reach the statutory retirement age, no longer pay medical insurance premiums, and enjoy medical insurance benefits for life.
4. If the insured does not have the continuous length of service or working years as stipulated in the first three paragraphs of this article, the actual medical insurance premium shall be paid for 30 years. After paying this number of years, if the insured reaches the statutory retirement age, he will no longer pay medical insurance premiums; Those who have not reached the statutory retirement age will continue to pay fees until they reach the statutory retirement age, and will no longer pay medical insurance premiums. During the insurance period, a large amount of medical mutual insurance will be paid every year.
Third, the medical insurance payment is interrupted?
When social security is interrupted, the account information in social security is blocked, which is useless and does not need to be returned. If you find the next company, you can transfer the social security paid by the original company to the social security account of this company. The impact of the interruption is that social security can't be used during the interruption, and you can re-participate, just like before. China stipulates that social security needs to be insured for 15 years, and there can be a gap in the middle, as long as you have been * *.
Relevant legal basis of medical insurance payment
1. Article 36 of the Regulations on Employees' Medical Insurance stipulates that employees who retire after the revision and implementation of this Ordinance shall pay the basic medical insurance premium, and the basic medical insurance treatment standard shall be implemented according to the regulations. When an employee retires, if the payment period of the basic medical insurance premium does not reach the provisions of the preceding paragraph, the basic medical insurance benefits he enjoys after retirement will be reduced by 5% on the prescribed treatment standard for each full payment period 1 year.
2. Article 27 of the Social Insurance Law stipulates that if an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the number of years stipulated by the state, he will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; 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.