1. Do you have a personal account?
The medical insurance premiums paid by the first-class insured are all used to establish a medical insurance pooling fund, and no personal account is established; Part of the medical insurance premiums paid by the two types of insured persons are used to establish medical insurance pooling funds and personal accounts. Personal account funds are based on my payment base and included in the following proportion:
1, people under 35 years old, the inclusion ratio is 3.3%;
2, more than 35 years old to 45 years old, included in the proportion of 3.5%;
3. Non-retirees over 45 years old, accounting for 3.7%;
4. Retirees will be paid 4% during the payment period and 4% after the expiration of the payment period, which is 60% of the average annual salary of employees in urban economic units in this city last year.
Second, the diagnosis range is different.
The second class has a wider range of special diseases than the first class, and the first class can only enjoy four special diseases, such as chemotherapy and analgesia for malignant tumors; Dialysis treatment for patients with renal failure; Anti-rejection therapy after renal transplantation; Hemophilia, etc. The second file can enjoy the treatment of 20 special diseases.
Third, reimbursement for different diseases.
On the payment period of medical insurance:
The minimum payment period of medical insurance for employees is 30 years for men and 25 years for women, of which the actual payment period must be 10 year according to regulations. When the above conditions are met, the medical insurance payment expires. After the expiration of the medical insurance payment period, those who have received a monthly pension can enjoy medical insurance benefits without paying the basic medical insurance premium for life, and large medical insurance premiums need to be paid for life.
If the actual payment period of the second file is over 10 years, you can enjoy the second file medical insurance treatment after the expiration of the medical insurance payment period; If the actual payment period of the second file is less than 10 years, you can choose to pay the second file and enjoy the second file medical insurance treatment after the medical insurance payment period expires. The specific payment shall be implemented in accordance with Article 1 of No.35 of People's Social Development [2013].
Medical insurance benefits for college students: 80% for general outpatient service.
"From 2065438 to September 2003 1, the general outpatient service for college students was arranged by the school hospital according to 50 yuan per person per year, and the balance was carried forward as an indicator, and the overrun was borne by the school hospital." According to the relevant person in charge of the Municipal People's Social Security Bureau, the expenses of going to other designated medical service institutions with the consent of the school hospital will be reimbursed by the school hospital according to regulations. Reimbursement funds are paid from the general outpatient places of college students arranged by the school hospital as a whole.
The reimbursement rate of medical expenses for students' general outpatient service is divided into two grades: 75% for the first grade and 80% for the second grade. The school year reimbursement capping line is determined by the school according to the number of insured college students, general outpatient medical care and the use of fund control quota. And in principle, it shall not be lower than the first individual payment standard of this school year.
When college students have fractures, joint dislocations and accidental injuries caused by foreign bodies in the respiratory tract without the third party's responsibility, 80% of their outpatient medical expenses will be reimbursed by the medical insurance fund, and the maximum amount per person per year is 1 10,000 yuan.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-third 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.
Article 24 The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.