There is no direct relationship between the payment period of social security and medical insurance and the reimbursement ratio. The reimbursement rate is related to your medication. Our drugs are divided into internal and external social security drugs. In addition, there are several factors that will affect the reimbursement ratio. 1. If you use social security drugs for external use, then the reimbursement ratio is zero, and social security is not reported. 3. Even if your medication is used within social security, the social security ratio will be reduced if it is transferred from this province to other places. 3. The reimbursement rate of social security in community hospitals is the highest. The higher the level from dimethyl to tertiary, the lower the reimbursement rate.
medical insurance, referred to as medical insurance, is a kind of social insurance. The reimbursement ratio of medical insurance is:
1. On-the-job employees: first-class hospitals, with 9% reimbursement from the overall fund and 1% paid by individuals; Secondary hospitals, 85% of the overall fund reimbursement, and 15% of the individual pays; Third-class hospitals, 8% of the overall fund reimbursement, 2% of the individual pays. 2. Retirees: first-class hospitals, 93% of the overall fund reimbursement, 7% of the individual pays; In the second-level hospital, 89.5% is reimbursed from the overall fund and 1.5% is paid by the individual; In Grade III and Grade A hospitals, 86% is reimbursed from the overall fund and 14% is paid by individuals.
3. Migrant workers (migrant workers' medical insurance is purchased in Guangzhou for foreign accounts): First-class hospitals, with 72% reimbursement from the overall fund and 28% paid by individuals; Secondary hospitals, 68% of the overall fund reimbursement, and 32% of the individual pays; In Grade III and Grade A hospitals, 64% is reimbursed from the overall fund and 36% is paid by individuals. Medical insurance reimbursement, simply put, is the cost you pay for medical treatment, which is partly borne by the state or unit, and the part of the burden is called reimbursement. China's medical insurance is divided into two parts: individual account and social pooling fund, which are jointly funded by units and individuals according to the prescribed proportion to ensure the basic medical needs of citizens. Among them, the overall fund is used to pay the hospitalization expenses, the personal account is used to pay the outpatient and emergency expenses and the drug purchase expenses of designated retail pharmacies, and the expenses that need to be borne by individuals in the specific items of hospitalization and outpatient services are also paid by personal accounts, and if the funds in personal accounts are insufficient, they are paid by individuals.
The medical insurance payment base does not affect the reimbursement ratio. The details are as follows:
1. The reimbursement rate of medical insurance is constant, and the medical insurance base has a certain relationship with salary and length of service. If you participate in medical insurance for urban and rural residents, the reimbursement rate will be 5%. If it is employee medical insurance, the reimbursement rate is 7%;
2. The medical insurance payment base is the base calculated by the medical insurance insured person paying the medical insurance fee according to a certain proportion. At present, the payment base of medical insurance in China is generally determined by my salary. If my total monthly salary exceeds 3% of the average monthly salary of employees in this city last year, it will be paid according to 3% of the average monthly salary of employees in this city last year. If the total monthly salary is lower than 6% of the average monthly salary of employees in this Municipality last year, the payment shall be made according to 6% of the average monthly salary of employees in this Municipality last year. However, due to the actual situation in different regions, the specific deposit base is determined according to the local actual situation. Once the payment base is determined, it cannot be changed within one year.
I hope the above contents can help you. If you have any questions, please consult a professional lawyer.
Legal basis:
Article 3 of the Social Insurance Law of the People's Republic of China
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) those that should be paid from the industrial injury insurance fund; (2) those that should be borne by a third party; (3) those that should be borne by public health; (4) those who seek medical treatment abroad.
the medical expenses shall be borne by the third party according to law. if the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.