Faced with the numerous social medical security projects, many people want to know the difference between basic medical insurance and critical illness medical insurance. In fact, basic medical insurance is an important part of the social security system. A kind of social insurance formulated by the government and jointly participated by the employer and employees. However, critical illness insurance is reimbursed on the basis of basic medical insurance, so there are still certain connections and differences between basic medical insurance and critical illness insurance. Now let me take you through what is the difference between basic medical insurance and critical illness medical insurance? Regarding the guide to medical insurance reimbursement, I have just compiled relevant content. I hope it will be helpful to you: How to use social security and medical insurance? This article teaches you the reimbursement application process!

What is the difference between basic medical insurance and critical illness medical insurance?

So what is the difference between them? Please follow me to find out more.

1. Different definitions

Basic medical insurance is a social insurance established by the state to subsidize workers’ certain personal economic losses caused by medical expenses. system.

The "critical illness medical insurance", that is, critical illness insurance for urban and rural residents, is a type of insurance purchased by the government from commercial insurance institutions. After the insured person's illness is reimbursed by the basic medical insurance, the individual still needs to pay for it. The medical expenses borne will be "reimbursed" again. Critical illness medical insurance does not refer to any serious illness. Simply put, it reimburses medical expenses on the basis of medical insurance.

2. Different payment standards

1. Basic medical insurance payment standards

a. The employer shall pay according to the employees of the unit (including retired employees) in the previous year. 6% of total salary is paid.

b. Individual current employees shall pay 2% of their salary income in the previous year.

c. If the average salary of the employer (employee) is lower than 60% of the average salary of the county's employees in the previous year, 60% will be used as the payment base; if it is 300% higher than the average salary of the county's employees in the previous year, 300% is used as the payment base.

2. The payment standard for critical illness medical insurance is 120 yuan per person per year (including retired employees), of which 70% is borne by the employer and 30% is borne by the individual employee. If the employer joins the insurance midway, it must pay the supplementary serious illness insurance premium according to the annual standard.

3. Different reimbursement scopes

1. Basic medical insurance reimbursement scope

a. Basic medical insurance pooling funds and personal accounts delineate their respective payment scopes, respectively. accounting. Medical expenses that are within the payment scope of the basic medical insurance fund shall be reimbursed in accordance with the basic medical insurance drug catalog, diagnosis and treatment item catalog, service facility scope and payment standards stipulated by each city.

b. Personal accounts pay the following medical expenses: outpatient and emergency medical expenses; expenses for purchasing medicines at designated retail pharmacies; medical expenses below the basic medical insurance co-ordination fund threshold; medical expenses exceeding the basic medical insurance co-ordination fund The minimum payment standard of the fund is the medical expenses that should be borne by the individual in proportion. Any shortfall in personal account shall be paid by myself.

c. The basic medical insurance pooling fund pays the following medical expenses: medical expenses for hospitalization; if the patient is kept under emergency rescue and admitted for hospitalization, the medical expenses for the 7 days before hospitalization will be used. The basic medical insurance fund will not pay for the following medical expenses: those who seek medical treatment at non-designated medical institutions, except for emergencies; those who purchase medicines at non-designated retail pharmacies; those who suffer injuries due to traffic accidents, medical accidents or other liability accidents; those who suffer from drug abuse , fighting or causing injuries due to other illegal activities; receiving treatment for suicide, self-mutilation, alcoholism, etc.

d. The medical expenses of enterprise employees who are injured or suffer from occupational diseases due to work shall be governed by the relevant provisions of work-related injury insurance. The medical expenses for childbirth of female employees shall be implemented in accordance with the relevant regulations of the state and each city.

2. Reimbursement scope of critical illness medical insurance: The coverage of critical illness medical insurance is mainly for the insured person who suffers from a serious illness and incurs high medical expenses. Medical expenses are guaranteed. With the goal of striving to avoid catastrophic household medical expenses for urban and rural residents, the compensation policy for critical illness insurance should be reasonably determined, and the actual payment ratio should not be less than 50%; the payment ratio should be formulated according to the level of medical expenses. In principle, the higher the medical expenses, the higher the payment ratio. .

The above is the difference between basic medical insurance and critical illness medical insurance. Although there are differences between the two, people who need sufficient security still need to purchase some commercial insurance for themselves to improve their protection. .

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