New medical insurance policy in 217

The news that retirees pay medical insurance has just come out and the personal contribution rate has been raised.

In recent years, medical insurance funds are facing unprecedented pressure of income and expenditure under the superposition of the three factors: the sharp increase of medical expenses, the slowdown of medical insurance financing and the aging population. The accumulated balance in many areas can not meet the requirement of "six to nine months" proposed by the Ministry of Human Resources and Social Security.

the data shows that the increase of per capita financial subsidies for urban residents' basic medical insurance has been higher than the increase of per capita individual contributions in the past six years, which makes the proportion of financial subsidies in the per capita total fund-raising increase from 6.8% in 29 to 79.3% in 214, and the ratio of financial subsidies to individual contributions is close to 4∶1. In 215, the government subsidy standard for urban residents' medical insurance is 38 yuan per person, and the individual contribution is not lower than that of 12 yuan.

Jin Weigang, director of the Social Security Research Institute of the Ministry of Human Resources and Social Security, believes that the current financing ratio of residents' medical insurance is unreasonable, and the growth of financing level mainly depends on finance. The proportion of financial subsidies in the whole financing ratio is too large, and the proportion of individual contributions is very small, which will lead to increasing pressure on medical insurance funds in the future.

In order to make up for the medical insurance gap, Lou Jiwei, Minister of Finance, once wrote in Qiushi magazine that we should deepen the reform of the social security system, accelerate the reform of the old-age insurance system, improve personal accounts and adhere to actuarial balance as the core, establish an incentive and restraint mechanism for overpaying and overpaying for a long time, and establish a more transparent and understandable payment and receipt system. On this premise, we will realize the national overall planning of employees' basic pensions, allocate state-owned capital to enrich the social security fund, accelerate the development of supplementary old-age insurance, and establish a reasonable growth mechanism for basic pensions, which is closely related to the contribution Reform the medical insurance system, establish a reasonable and sustainable medical insurance financing mechanism, study and implement the payment policy for employees' medical insurance retirees, establish an adjustment mechanism for medical insurance benefits commensurate with the level of financing, fully implement the serious illness insurance system for urban and rural residents, reform the payment method of medical insurance, integrate the basic medical insurance system, promote the de-administrative reform of public hospitals, and run township and village hospitals in combination with new urbanization to truly establish an orderly graded diagnosis and treatment pattern.

Among them, the research and implementation of the payment policy for employees' medical insurance retirees has aroused great concern. According to estimates, if retirees pay medical insurance, they will use the average pension as the base. In this way, according to the 215 standard, the average contribution of retirees may be about 1 yuan per person per month.

in addition, many local governments explore and encourage residents to buy commercial insurance. In December last year, the Ministry of Finance, the State Administration of Taxation and the China Insurance Regulatory Commission issued a notice to implement a pilot personal income tax policy for commercial health insurance in 31 cities, including Beijing and Shijiazhuang, Hebei Province. The expenses of individuals purchasing qualified health insurance products in the pilot areas were deducted before personal income tax according to the limit of 2,4 yuan/year.

how much should medical insurance pay in p>217

1. The main purpose of medical insurance card

1. The main purpose of medical insurance is to pay for outpatient treatment.

2. There are other uses of medical insurance. You can use the money to buy medicines (over-the-counter drugs), medical instruments, thermometers and blood pressure monitors at designated pharmacies.

Second, how to use the money in the medical insurance card account

As we all know, employee medical insurance is generally divided into individual accounts and overall accounts. How to use these two accounts respectively?

Personal account can pay the following expenses:

1. Drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;

2. It is used to purchase commercial insurance, accident insurance, etc.;

3. Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund;

4. If the threshold of the basic medical insurance pooling fund is exceeded, bear the personal expenses in proportion;

5. If the personal account is insufficient to pay the part, I will pay it.

The overall account mainly pays the following expenses:

1. Medical expenses for hospitalization;

2. Outpatient medical expenses for taking anti-rejection drugs after radiotherapy for malignant tumor, renal dialysis and renal transplantation;

3. The medical expenses of patients admitted to hospital after emergency rescue shall be observed for seven days before hospitalization.

Third, the scope of medical insurance reimbursement

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization caused by diseases and some accidents in designated hospitals.

the reimbursement formula is: (total expense-threshold expense-self-expense-cost overrun) *(75+ age *.2)%. Under normal circumstances, the actual reimbursement ratio ranges from 2% to 6%.

Self-funded drugs are not reimbursed, and 8% of Class B drugs are reimbursed. Bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of medical insurance card is four times the average salary of local social workers (accumulated value within one year).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4. Reimbursement of serious illness insurance

After the insured suffers from a serious illness, the personal conceit part that occurred in the designated medical institutions of the municipal medical insurance and met the requirements of the municipal medical insurance will be included in the payment scope of the residents' serious illness insurance, and 5% will be reimbursed by the serious illness insurance funds.

that is, reimbursement amount = self-funded part ×5%

IV. Reimbursement ratio of medical insurance card

In July this year, the Ministry of Human Resources and Social Security announced the Outline of the Thirteenth Five-Year Plan for the Development of Human Resources and Social Security, and China will stabilize the proportion of hospitalization expenses paid by employees and urban and rural residents within the basic medical insurance policy at around 75%.

V. New uses of medical insurance card

1. It can be used as an ID card

On October 1, 215, the Criminal Law Amendment (IX) included the social insurance card in the scope of documents that can be used to prove identity according to law. Whoever forges, alters or buys or sells social security cards shall be investigated for criminal responsibility according to law; Anyone who uses a forged, altered or stolen social security card of others shall be investigated for criminal responsibility according to law.

2. Some provinces and cities can be used for fitness

In the second half of this year, employees in some provinces and cities such as Shandong, Chongqing and Jiangsu can use their personal account balance to carry out fitness activities in fitness venues. But it may not be used to buy food, clothing, fitness equipment or cash.

VI. Attention should be paid to using the medical insurance card

1. It is forbidden to cash out

No unit or individual is allowed to violate the use scope and requirements of the medical insurance card, and it is strictly forbidden to withdraw cash.

2. Some provinces and cities can use medical insurance cards for the whole family

From the second half of this year, some provinces and cities, such as Zhejiang Province and Guangzhou City, the surplus funds of medical insurance personal accounts over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, thus realizing mutual assistance among family members.

3. Medical insurance will not pay for the following situations

See a doctor in a non-designated medical structure or buy medicine in a non-designated retail pharmacy (except for emergency);

self-injury caused by fighting, drug abuse or other illegal acts;

treatment due to alcoholism, suicide, self-mutilation, etc.;

injuries caused by traffic accidents, medical accidents or other liability accidents;

and the situation that the individual should pay according to the national or local regulations.

VII. How to inquire about the balance of medical insurance card

Insured personnel can call 12333 social security consultation telephone or inquire about the balance of personal medical insurance account through Bank of China savings office, designated hospitals in urban areas and pharmacies.

Finally, if you are still unclear about medical insurance, you can call the 12333 human resources and social security hotline for consultation.

With the medical insurance card in hand, life is guaranteed. Therefore, we must keep it well and use it reasonably, which can save money for ourselves and save trouble. Put away

Extended reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.