Medicare refers to social medical insurance. It is a social insurance system for the basic medical needs of workers when they are sick according to the laws and regulations of the state and society.
:
Medicare has the characteristics of "low level, wide coverage", with contributions based on a low level of the vast majority of units and individuals can afford to pay, broad coverage of all units and workers in urban areas, and workers of different nature units can enjoy the basic Employees in units of different natures can all enjoy the right to basic medical insurance. Participants can enjoy the right to basic medical insurance for the rest of their lives after completing their contribution period. Secondly, the basic medical insurance is characterized by the "two sides of the burden, the unification of the accounts"; "to determine the expenditure with income, revenue and expenditure balance" as the principle.
Advantages:
Enjoying the treatment according to the unified standard. The same conditions of access, the same charges, enjoy the same treatment, there is no difference between high and low. Employees' outpatient expenses can be deducted from their personal accounts, and after the deduction, the employees will pay by themselves. Employees' hospitalization expenses are reimbursed on a pro rata basis: 86% for 10,000 yuan of expenses at a tertiary hospital; 88% for 10,000 to 20,000 yuan of expenses at a tertiary hospital; and 92% for 20,000 to 40,000 yuan of expenses at a tertiary hospital. If the employee does not get sick for several consecutive years personal account funds can be accumulated and rolled over.
Deficiencies:
There is a basic starting deductible for each hospitalization, which is 500 yuan for Level 1 hospitals, 750 yuan for Level 2 hospitals, and 1,000 yuan for Level 3 hospitals, and these costs need to be borne by the employees themselves. Category A and B drugs are reimbursed on a sliding scale, imported drugs are not reimbursed, and you have to pay for them yourself if they exceed the 40,000 yuan coverage limit.
What types of basic health insurance are there?
Basic health insurance is for all citizens of China, whether or not they have a job, they can participate in health insurance. At present, there are two types of basic medical insurance in China: basic medical insurance for employees and basic medical insurance for urban and rural residents.
Employee health insurance: mainly for the unit of workers, if you have a formal job, you will be able to participate in the unit of employee health insurance; migrant workers into the city also have the right to participate in the employee health insurance, as long as there is an employment unit, signed a labor contract and establish a stable labor relationship with the enterprise, the employer should be in accordance with the provisions of the state clearly the responsibility to pay, and participate in the basic employee health insurance.
If you are not an employee of the unit, there are two options to participate in the health insurance:
1, participate in the basic health insurance for urban and rural residents, to be able to enjoy financial subsidies on the basis of individual contributions;
2, is the employee health insurance, but is the employee health insurance for the flexibly employed, in accordance with the provisions of the second paragraph of Article 23 of the Social Insurance Law, to participate in the employee basic health insurance in the capacity of individuals The first step is to make sure that you are paying the basic medical insurance premiums in accordance with the provisions of the law.
You can choose whether to participate in the employee health insurance or the resident health insurance according to your actual situation and needs.
What is the difference between employee and resident health insurance?
First of all, the amount of contribution is different. The employee health insurance is paid once a month, and the resident health insurance is paid once a year; cumulatively, the employee health insurance will pay more per year.
Secondly, the treatment is different. Employee health insurance contributions more, enjoy the treatment is also higher than the residents of the health insurance, such as reimbursement ratio is higher, there are individual accounts can be used in the outpatient clinic, the pharmacy to buy drugs.
Lastly, the employee health insurance can enjoy the retirement exemption treatment after paying the required number of years. The residents of the medical insurance does not have exemption treatment, you must pay the annual contributions on time to enjoy the treatment.