1. How does the insured unit pay the basic medical insurance premium?

1. Agencies, institutions, and municipal enterprises whose personal accounts are uniformly established and managed by medical insurance agencies shall declare on a monthly basis the sum of 8% of the average monthly salary of employees at the municipal level in the previous year based on the sum of active employees and retired personnel.

Pay basic medical insurance premiums.

2. If the personal account is temporarily established and managed by the employer, 5.5% of the average monthly salary of employees at the city level in the previous year shall be declared on a monthly basis based on the number of insured persons in the unit.

Pay part of the overall fund.

2. Do retired (employee) personnel need to pay basic medical insurance premiums?

According to our city's "Interim Regulations", retired (employee) personnel do not pay basic medical insurance premiums.

3. To participate in and enjoy basic medical insurance, what are the payment period requirements?

Employees who retire after July 1, 2001 can continue to participate in and enjoy the employee basic medical insurance if the cumulative number of pension insurance payment years (including deemed years) at the time of retirement is no less than 25 years for men and no less than 20 years for women.

Those who are dissatisfied should be replenished.

The back-payment fee shall be based on the payment standard at the time of top-up. The employer shall be responsible for making up the unpaid amount, and the remaining payment shall be made by the individual employee.

4. How to form a basic medical insurance personal account?

Retirees: 1. Those under the age of 75 (inclusive) are classified as 4.5% of the average salary of city employees at the same level in the previous year; those over 75 years old are classified as 5% of the average salary of city employees at the same level in the previous year.

2. Interest on deposit amount.

5. What is the scope of use of personal accounts?

The personal account is mainly used for the part of the insured person's outpatient medical expenses, drug purchase expenses, hospitalization and medical expenses for specified diseases that are borne by the individual in designated medical institutions and designated pharmacies that comply with the provisions of basic medical insurance (except for the part paid by the individual)

, which is applicable every year. If there is any balance at the end of the year, it can be carried forward to the next year for continued use.

6. What is not covered by the basic medical insurance pooling fund?

1. Failure to seek medical treatment and purchase medicines in accordance with regulations or seek medical treatment and purchase medicines at non-designated medical institutions or non-designated pharmacies without approval.

2. Medical expenses incurred due to illegal crimes, suicide, self-mutilation, fights, drug abuse, alcoholism, etc.

3. Medical expenses during travel abroad and abroad.

4. Traffic accidents, medical accidents, large-scale food poisoning and compensation liabilities of others should be paid.

5. Work-related injuries and relapse of old work-related injuries of employees included in the scope of work-related injury and maternity insurance for female workers, as well as the cost of maternity and family planning surgeries for female workers.

7. What is the minimum payment standard for the basic medical insurance pooling fund?

The minimum payment standard of our city's current policy is 1,200 yuan, the second hospitalization within the accounting year is 960 yuan, and each hospitalization after the third time is 720 yuan.

8. What is the maximum payment limit of the basic medical insurance pooling fund?

The maximum payment limit in our city is 40,000 yuan. Medical expenses exceeding the maximum payment limit are not covered by the basic medical insurance.

Prorated by Supplemental Medicare.

9. How is the proportion paid by the city’s basic medical insurance fund determined?

For medical expenses above the minimum payment standard and below the maximum payment limit, the basic medical insurance overall fund payment ratio for current employees, "double payment and double insurance" and retired personnel in our city is: 1,200 (exclusive) - 10,000 yuan, and 84 for first-level hospitals

%, 81% for second-level hospitals, 78% for third-level hospitals; 10,000 (exclusive) - 20,000 yuan, 87% for first-level hospitals, 84% for second-level hospitals, 81% for third-level hospitals; 20,000 (exclusive) - 30,000 yuan,

90% of first-level hospitals, 87% of second-level hospitals, and 84% of third-level hospitals; 30,000 (exclusive)-40,000 yuan, 93% of first-level hospitals, 90% of second-level hospitals, and 87% of third-level hospitals.

The payment ratio of the basic medical insurance pooling fund for retirees and those who have reached the normal retirement age will be increased by five percentage points from the corresponding level for active employees; for older workers who participated in revolutionary work before the founding of the People's Republic of China, the personal burden ratio will be 50% of that of retirees.

The settlement of outpatient medical expenses for specified diseases is based on the first and second half of the Gregorian calendar as two settlement time periods respectively. If it is less than half a year from the beginning of the first half of the year or the end of the second half of the year, it will be calculated as one settlement time period, and the minimum payment standard is 1,200 yuan.

.

The minimum payment standard for the second settlement period within the calendar year is 960 yuan.

The medical fee pooling fund for the portion above the minimum payment standard is paid in proportion to the same level as the third-level hospital.

The thresholds for outpatient and inpatient treatment are calculated separately.

It is stipulated that the cost of expert identification of disease types shall be borne by the individual.

10. How to calculate the benefits of basic medical insurance for insured persons?

Example 1: An insured person is sick and hospitalized in a city's second-level designated hospital. The hospitalization fee is ***12,137 yuan, of which 37 yuan is not covered by basic medical insurance (air conditioning fees, etc.). The calculation is as follows: 1

.Medical expenses within the scope of payment; 12137-37 = 12100 yuan.

2. The minimum payment for medical expenses below the standard is 1,200 yuan.