1, flexible employees who participate in the basic medical insurance for employees shall pay as a whole according to a single building, with the standard of 294 yuan per person per month (3,528 yuan/person-year) and the standard of 480 yuan per person per month (5,760 yuan/person-year).
2, to receive unemployment insurance personnel to participate in the basic medical insurance payment standard for 630 yuan per person per month.
3, to participate in the basic medical insurance for urban and rural residents, the individual payment standard is 380 yuan per person per year.
Benefits of medical insurance payment:
1. Hospitalization reimbursement: First, the insured patients in Qi 'an go to any first-class hospital, second-class hospital and third-class hospital in the city and Qi 'an with social security cards or residents' health cards (poor households who need to bring poverty alleviation manuals when establishing a card), and they will be reimbursed directly when they leave the hospital. The deductible lines are 200 yuan, 600 yuan and 1500 yuan respectively, and the reimbursement rates in the catalogue are 90%, 75% and 65% respectively, and the top line is 200,000 yuan. Second, insured patients can enjoy serious illness insurance when they leave the hospital in the city. After the reimbursement of basic medical insurance, the expenses can be reported in the remaining directories, with the deductible line of10.4 million yuan, which will be reimbursed in proportion with the basic medical insurance and settled in one stop, with the top line of 300,000 yuan. Third, the poverty-stricken households who set up the card can enjoy the five guarantees of basic medical insurance, serious illness insurance, medical assistance, bottom insurance and government bottom insurance, and the designated medical institutions in the city can enjoy one-stop settlement of basic medical insurance, serious illness insurance and medical assistance. Fourth, when the low-income households, five-guarantee households, orphans, three-no-personnel, and poor households with filing cards are hospitalized in the flag, medical assistance and basic medical insurance will be implemented in one-stop settlement. Fifth, there is no deductible for insured five-guarantee households, orphans and disabled persons (Grade I and II), and the deductible for children, students and minors is reduced by 50%. Sixth, after the insured person is referred for the record, he can be hospitalized in a designated tertiary hospital outside the city (designated secondary and above specialized hospitals in different places), and can be directly reimbursed in different places. The deductible line is 2,500 yuan, the reimbursement ratio in the catalogue is 55%, and the capping line is 200,000 yuan. Seventh, maternal and child protection. Before the newborn is born, you can go through the registration formalities at the medical insurance agency where the household registration is located, and the hospitalization expenses incurred in that year can be reimbursed. The reimbursement policy refers to the reimbursement policy for adult residents. Eighth, the insured can claim compensation for accidental injury (accidental injury) within the insurance scope after insurance, with the deductible of 1 10,000 yuan, and the reportable expenses can be reimbursed by 50%, with the capping line of 1 10,000 yuan.
2. Outpatient reimbursement: First, the deductible line of general outpatient service in that year is 50 yuan, with the reimbursement ratio of 50%, and the highest payment limit in that year is 200 yuan. Second, the insured with chronic diseases, "two diseases" and targeted drugs can be reimbursed for hundreds to tens of thousands of yuan within one year according to different diseases. Three, outpatient minor surgery can be directly reimbursed in the designated medical institutions in the city. The deductible line is 300 yuan, and the reimbursement rate is 70%. The top line is 1.200 yuan.
Precautions for medical insurance payment:
1, one thing that employees should pay attention to in medical insurance payment is that the insured needs to ensure the continuity of participation. Employee medical insurance needs to be paid every month. Once the employee's medical insurance is paid off, the insured person will not be able to make medical insurance reimbursement next month. If the payment is interrupted for more than three months, the original medical insurance payment period will be cleared. At this time, paying medical insurance can only be considered as re-insurance. It is still expensive to start calculating the payment period. Do not use medical insurance, the implementation of medical treatment.
2. Another thing to note is the payment period of employee medical insurance. The payment period of employee medical insurance is still relatively long, and the payment period of medical insurance varies from place to place. In some places, it takes 25 years for men and 20 years for women. In some areas, men are required to pay for 30 years, and women need to pay for 25 years. Although the medical insurance payment period is regarded as the payment period, I am willing to join the calculation. However, as the insured population of employee medical insurance becomes younger and younger, the number of insured people who can meet the requirements of deemed payment period is relatively small. For example, for young people who start to enter the workplace after 00, there is no cumulative calculation as the payment period. Most people still need to pay according to the local payment period requirements. Although employee medical insurance allows one-time payment, the cost of one-time payment is still relatively large. Try to ensure that you can meet the requirements of the payment period before retirement.
To sum up, the implementation of medical insurance for urban residents can fundamentally solve the problem of "difficult and expensive medical treatment" and obviously improve the situation of "poverty caused by illness", which is the gospel of the vast number of urban and rural residents.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23
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.