1, the payment ratio is different. The proportion of primary medical insurance payment is 8.2%, the unit payment is 6.2%, and the individual payment is 2%. The contribution rate of the second-grade medical insurance is 0.8%, the unit contribution is 0.6%, and the individual contribution is 0.2%. The payment base is the average monthly salary of employees in the previous year, with a total payment of 59.8 yuan;
2, the applicable population is different. Generally well-known large companies, listed companies, etc. Purchased by medical insurance; The second medical insurance is generally paid by the company.
3. The principle of seeking medical treatment is different. The insured person can seek medical treatment at any designated medical institution in the city; The second-level insured person goes to the binding social health center for medical treatment, is hospitalized in any designated medical institution in the city, and is seriously ill and goes to the prescribed medical institution for medical treatment;
4. Hospitalization reimbursement is different. 90% of first-class hospitalization reimbursement needs to be handled in designated hospitals; 90% of second-level hospitalization reimbursement needs to be handled in designated hospitals;
5. Outpatient reimbursement is different. The first class has been insured continuously for 12 months, and 70% can be reimbursed for the part that exceeds 3 13 1 yuan at its own expense throughout the year; Social health clinics report 30%; Large equipment inspection report 80%; The second file is the annual outpatient fee 1 000 yuan, which needs to be bound to the community health hospital. Maximum amount of outpatient large-scale equipment inspection and treatment 1.20 yuan;
6. The time requirements for registration are different. If the primary insured person has been insured for one year in a row, and the basic outpatient medical expenses and supplementary medical expenses paid by himself exceed 5% of the average wage of employees on the job in the same medical insurance year, the excess part shall be paid by the overall fund according to the regulations, and the secondary insured person has no specific time requirements.
The legal provisions of medical insurance are as follows:
1, 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;
2. 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.
In short, the scope of medical insurance reimbursement ratio varies from place to place. Please refer to local policies for details. The insured person can enjoy the basic medical insurance right for life after completing the payment period, and can enjoy medical reimbursement and medical insurance benefits after retirement. Medical insurance can guarantee citizens' right to get material help from the state and society in old age, illness, work injury, unemployment and childbirth.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
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.