People who participate in medical insurance will have their own medical IC card, so where does the money on the medical IC card come from? The funds on the medical insurance IC card come from two parts: first, all of the medical insurance premiums paid by the individual employee are credited to the medical IC card, and the amount of funds is generally 2% of his or her salary income; second, the funds are allocated by the medical insurance management department from the medical insurance premiums paid by the employing organization for the employee. The employer's contribution to the employee's health insurance is generally 6% of the employee's salary, and the health insurance administration will deposit 30% of this 6% into the employee's medical IC card. The exact percentage deposited varies depending on age and location. Generally speaking, 30 percent is deposited for those under 45, 50 percent for those over 45, and 75 percent for retirees.
Where will that remaining portion be deposited? The health insurance administration organization will deposit the rest of the money into the Social Co-ordinated Medical Fund (SCMF), which can be used by the insured when they need to pay large medical bills.
What kinds of medical treatments can I use my card for
What kinds of medical treatments can I use my card for? Generally speaking, outpatient emergency medical fees, emergency ambulance fees, the cost of drugs purchased at designated retail pharmacies in accordance with the relevant provisions of the medical insurance, as well as hospitalization fees, medical fees below the starting standard of the coordinated fund and medical fees above the starting standard that require personal out-of-pocket expenses, outpatient major diseases, family beds, and medical fees required to be paid by an individual (depending on the local regulations), can be used with the card to pay for the medical insurance.
But there are some items and expenses that cannot be reimbursed, which are summarized in the following five categories:
The first category is the service item category: registration fee, out-of-hospital consultation fee, medical record cost, etc.; visit fee, examination and treatment of expedited fee, surcharge on named surgery, high quality and premium fee, self-invited special nurses, and other special medical services.
The second category is the category of non-disease treatment programs: all kinds of cosmetic, body-building programs and non-functional plastic surgery, orthopedic surgery, etc.; all kinds of weight-loss, weight gain, height increase programs; all kinds of health checkups; all kinds of preventive, health care diagnostic and therapeutic programs; all kinds of medical consulting, medical appraisal.
The third category is diagnostic and treatment equipment and medical materials: the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program; glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitation devices; a variety of self-use health care, massage, inspection and treatment equipment; the provincial pricing departments can not be charged separately for disposable medical materials. The disposable medical materials.
The fourth category is the treatment project category: all kinds of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation; myopic eye orthopedics; qigong therapy, music therapy, health care nutrition therapy, magnetic therapy and other auxiliary treatment projects.
The fifth category is other categories: various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs; a variety of scientific research, clinical verification of the diagnosis and treatment programs. Transportation fees for consultation (referral), emergency vehicle fees; air-conditioning fees, television fees, telephone fees, baby incubators, food incubators, electric stoves, refrigerators and compensation for damage to public property; escort fees, nursing fees, cleaning fees, outpatient decoctions; meals; recreational activities and other special needs living services.
Do you still need major disease insurance when you have medical insurance
Many local governments require that units and individuals must also pay for major medical supplemental insurance after paying into the social medical insurance fund, with the aim of providing peace of mind when treatment costs exceed the amount stipulated by medical insurance. After paying the supplementary medical insurance, the patient only needs to bear 5 to 30 percent of the medical expenses.
It's important to note that there is a cap on medical supplemental insurance, and regulations vary from place to place, generally ranging from 100,000 yuan to 200,000 yuan. For the average person, 100,000 yuan to 200,000 yuan of insurance is already enough, of course, if you need more comprehensive protection, you can go to the insurance company to choose some critical illness insurance.
How to use the health insurance card
With the health insurance IC card, you can go to the designated hospitals to solve the problem of seeing the doctor easily. When playing the card to see the doctor, you may encounter these problems, one is not clear about how much money they have on the card; the second is how to reimburse the medical expenses; the third is whether the remaining money on the card will also be credited interest.
Let's take Xiao Wang of Chongqing as an example to see how the money on his health insurance card accumulates and how the cash he needs to pay when he sees a doctor is calculated.
Wang is now 35 years old, with a monthly salary of 2,700 yuan, and has accumulated 25 yuan on his personal medical card in the previous year, and 317.8 yuan on his card from January to March this year. This year, he has seen the doctor three times, *** spent 230 yuan on medical expenses, and this time he spent 120 yuan on medical expenses. According to Wang's specific situation, the total amount of personal account funds at his disposal consists of three parts: ① Individual contributions: 2700 × 2% × 3 = 162 yuan; ② unit contributions: 2700 × 6% × 30% × 3 = 145.8 yuan; ③ the amount of the previous year's accumulation of the transfer of the amount: 25 yuan. The above three accumulated, that is, for his personal account total funds 332.8 yuan this year.
So how does the personal account pay? According to the regulations, the participant's medical expenses are divided into three stages. Medical expenses are first spent from the money on the individual IC card, and when the money on the IC card runs out, the individual enters the self-payment stage. Generally speaking, the out-of-pocket stage has an upper limit, and any amount not reaching the upper limit is to be borne by oneself. For example, Chongqing stipulates that those who spend less than 400 yuan on individual treatment will be responsible for the rest of the cost after spending the amount on their IC cards.
When the treatment cost exceeds the upper limit of the self-payment stage, the participant enters the social coordination stage. At this stage, the participant's treatment costs are borne by the social insurance management unit, but the individual still has to bear a certain percentage of the costs, which varies from place to place. Chongqing stipulates that medical expenses below 5,000 yuan of personal responsibility for 25%; 5,001 ~ 10,000 yuan, personal responsibility for 20%; 10,000 yuan to the previous year, the coordinating area of the basic medical insurance per capita contribution base of less than four times, pay 15%; if the amount exceeds, it does not belong to the scope of the basic medical insurance, which can be to participate in the medical insurance for serious illnesses.
In Xiao Wang's case, the first three visits to the doctor in the current year had cost him 230 yuan in medical fees, and the current medical fee was 120 yuan, with a cumulative medical fee of 350 yuan, at which time there was not enough money in the individual medical IC card to pay for it, and it entered the individual out-of-pocket section (but not yet in the co-ordination section), so he should have paid 17.2 yuan in cash out of his own pocket (i.e., the 350 yuan medical fee he had spent, less the total amount of 332.8 yuan in the individual IC card). The total amount of 332.8 yuan)
So how can Wang be reimbursed and settled for this visit to the doctor? Experts remind that the insured person can settle the bill with the hospital directly after the outpatient treatment and keep the documents, and the cost of medical insurance visit is reimbursed according to the level of the hospital and the amount of the cost, in general, the higher the level of the hospital, the lower the proportion of the cost reimbursement. The reimbursement needs to be approved and signed by the administrative department of labor security first and then to the medical insurance center for reimbursement, and the reimbursement must have the details of the medical expenses, admission diagnosis, a copy of the medical record, a letter of introduction from the unit, a copy of the unit's payment receipt, a copy of the medical card, the diagnosis of the hospital discharge, as well as the laboratory examination reports and receipts, and so on.
What if the money in the IC card is not used up? According to the relevant provisions of the individual IC card balance of funds is to pay interest. The specific calculation standard is: the part of the year raised by the demand deposit interest rate; the previous year's carry-over funds at 3-month whole deposit bank deposit rate. The principal and interest in the medical IC card are owned by the individual and can be carried forward for use and inheritance.
How to apply for health insurance for flexibly employed people
Mr. Mai in Nanning used to work in a factory, but later he was laid off and became a flexibly employed person. The absence of a unit means that he has no medical insurance, so how does a flexibly employed person like Mr. Mai apply for medical insurance?
In fact, flexibly employed people can go to the local social medical insurance center for basic medical insurance. All you need is an ID card, a one-inch color photo, a pension insurance handbook, a recent pension insurance payment receipt, and a copy of each of the above documents, and then go to the registration desk at the health insurance center and submit the above information to the administrator for processing.
Three months after completing the procedure, the flexibly employed person will be able to receive his or her health insurance IC card. The money allocated to the individual account of a flexibly employed person is based on the previous year's average social wage or retirement contributions, and the percentage allocated varies from place to place. In the case of Mr. Mak, for example, 1% is allocated for those aged 45 and below, 1.4% for those aged 45 and above until retirement, and 3.8% for retirees. Taking the 2004 local average social wage of 933 yuan per month as an example, Mr. Mak is 42 years old, so 1% of 933 yuan will be transferred to his personal account of 9.33 yuan per month.
Who is considered a "flexible worker"? "Flexible employment personnel" mainly refers to three forms of employment, one is self-employed, refers to the establishment of their own enterprises as both bosses and employees; the second category is freelance, refers to the individual capacity to obtain remuneration through labor, such as freelance writers; the third category is the "family helpers ", referring to people who work for a family business.
What about health insurance for job hoppers? When the insured person moves within the insured district or county, only the basic medical insurance relationship is transferred, not the personal account storage amount; when moving across districts and counties or across the coordinated districts and counties, it is necessary to transfer the basic medical insurance relationship at the same time as the transfer of the personal account storage amount.