Legal basis: Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law.
Article 8 The medical expenses incurred by the insured in the agreed medical institutions shall be paid by the basic medical insurance fund in accordance with the provisions of the state if they meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.
The difference between individual medical insurance and unit medical insurance
Object-oriented differences:
First of all, the people with personal medical insurance are mainly unemployed people, low-income families, children and students.
The groups applying for unit medical insurance are mainly individual industrial and commercial households, as well as people who have jobs and can be employed flexibly.
Different payment standards:
First of all, personal medical insurance is paid once a year, and the collection period is generally from September to 65438+February each year to pay for the next year's expenses. If you don't pay during the payment period, there will be a waiting period, during which you are not covered by medical insurance.
The unit medical insurance is paid monthly. Payment is usually required before the first day of each month. If the payment is overdue, a late fee will be charged. Suppose your medical expenses are incurred during the unpaid period and cannot be reimbursed.
How to pay personal medical insurance?
If you are a resident of this city, you can bring your original ID card, residence booklet, photocopy and 1 inch color photo to the community neighborhood committee or social security office to register and pay.
If you are a rural resident, you can choose to participate in rural cooperative medical care. If you need to participate, the village Committee will tell you how to submit the information and then handle it in a unified way.
If you are self-employed, you can choose to set up a pool fund instead of a personal account, and pay the basic medical insurance premium at 4.2% of the local average monthly salary in the previous year. Or you can choose to pay a personal account at 8% of the local average monthly salary in the previous year.
The expenses are calculated according to the local average social wage in the previous year, which varies from year to year. Payment in the name of an individual must be submitted to the social security bureau where the account is located.
Processing materials include: personal identity card, two recent one-inch bareheaded photos, insurance premium, application form, etc.