1, proportion of medical insurance reimbursement for employees in tertiary hospitals:

(1) The medical expenses are 30,000 yuan: 85% is paid by the basic medical insurance pooling fund, and15% is paid by individual employees;

(2) The part exceeding 30,000 yuan to 40,000 yuan: 90% can be paid by the basic medical insurance fund, and the employee needs to pay10%;

(3) Medical expenses exceeding 40,000 yuan: 95% can be paid by the overall fund, and 5% can be paid by individual employees.

2, secondary hospital staff medical insurance reimbursement ratio:

(1) 30,000 yuan: the overall fund payment can reach 87%, and the individual employee payment can reach13%;

(2) Medical expenses ranging from 30,000 yuan to 40,000 yuan: 92% paid by the overall fund and 8% paid by individual employees;

(3) The part exceeding 40,000 yuan: the payment from the basic medical insurance pooling fund can be as high as 97%, and the individual payment of employees is only 3%.

If the employer and its employees pay medical insurance premiums in accordance with the regulations, the employees can enjoy the basic medical insurance benefits from the month following the payment of medical insurance premiums; Workers who have not paid medical insurance premiums cannot enjoy basic medical insurance benefits.

If the employer applies for holdover of medical insurance premiums in accordance with relevant regulations, the employees will not stop enjoying the basic medical insurance benefits during the approved holdover period.

Employers and their employees who should pay medical insurance premiums but have not paid them can continue to enjoy basic medical insurance benefits after paying medical insurance premiums in full.

If the number of years (including deemed payment period) that the employer and its employees have paid medical insurance premiums exceeds 15 years, the employees can enjoy basic medical insurance benefits after retirement. As for the calculation of the payment period, it shall be stipulated separately by the Municipal Human Resources and Social Security Bureau.

Workers can receive pensions in the month when they reach the statutory retirement age and go through retirement procedures. The basic medical insurance premium paid by the employer is included in its personal medical account, and it is included according to the inclusion standard of the last month of its employment; The payment of medical expenses shall be implemented in accordance with the provisions of the basic medical insurance for retirees.

Retirees who have enjoyed basic medical insurance benefits in accordance with the relevant provisions before the implementation of these measures are not subject to the restrictions stipulated in this article.

Second, the difference between employee medical insurance and resident medical insurance

The differences between employee medical insurance and resident medical insurance are as follows:

1. Different targets: residents' medical insurance is mainly aimed at unemployed residents, low-income households, students and children; Employee medical insurance is aimed at working units or flexible employees, individual industrial and commercial households, etc.

2. Different sources of expenses: residents' medical insurance is paid by individuals and subsidized financially; The amount of general financial assistance is much more than that paid by individuals; Employee medical insurance is jointly paid by units and individuals, with 8% for general units and 2% for individuals;

3. Different payment standards: residents' medical insurance is paid annually, and there is a collection period; Employees' medical insurance is paid on a monthly basis, which is generally stipulated to be paid before the date of each month. If the payment is overdue, there will be a late fee.

4. Enjoy different treatment: residents' medical insurance contributions are low, so the treatment is low, and the reimbursement ratio is generally around 45% ~ 65%; Employees pay medical insurance on a monthly basis with high pay, and the reimbursement ratio is generally around 70% ~ 90%;

5. Different payment requirements: residents' medical insurance must be paid annually, and they cannot enjoy treatment without paying. If it is interrupted, it may be necessary to pay the fees of previous years; Employees can retire with medical insurance, generally requiring men to be 25 years old and women to be 20 years old; There is no need to pay after retirement, and a personal account is drawn every month.

Third, what is the impact of employee medical insurance interruption payment?

If the payment is interrupted within 3 months and continues to be paid, Chongqing medical insurance benefits will be enjoyed from the next month after the expenses are paid off. Medical expenses incurred during the overdue period shall be paid in accordance with regulations; For more than 3 months in a row, Chongqing medical insurance benefits will be enjoyed from the next month after the payment. Medical expenses incurred during the overdue period shall not be paid according to regulations. During the period of unpaid medical insurance premiums, the part paid by the unit in proportion will not enter the personal account of medical insurance.

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Twenty-seventh measures for the implementation of basic medical insurance for urban and rural residents in Hunan Province

The hospitalization expenses of insured residents within the policy scope of designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.

Article 28

Insured residents are hospitalized in provincial-level designated medical institutions, and the Qifubiaozhun is determined according to about 10% of the average hospitalization expenses of each provincial-level designated medical institution in the previous year, not less than 1500 yuan. Within the scope of the policy, the proportion of hospitalization medical expenses paid shall not be less than 50%. The specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of the medical insurance fund for urban and rural residents and the medical conditions of the insured residents in the overall planning areas.

Article 30

The medical insurance fund for urban and rural residents sets the maximum payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million yuan.

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Twenty-seventh measures for the implementation of basic medical insurance for urban and rural residents in Hunan Province

The hospitalization expenses of insured residents within the policy scope of designated medical institutions of basic medical insurance in the overall planning area shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.

Article 28

Insured residents are hospitalized in provincial-level designated medical institutions, and the Qifubiaozhun is determined according to about 10% of the average hospitalization expenses of each provincial-level designated medical institution in the previous year, not less than 1500 yuan. Within the scope of the policy, the proportion of hospitalization medical expenses paid shall not be less than 50%. The specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of the medical insurance fund for urban and rural residents and the medical conditions of the insured residents in the overall planning areas.

Article 30

The medical insurance fund for urban and rural residents sets the maximum payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 6.5438+0.5 million yuan.