(1) for employees under 35 years of age, 1.3% of the base amount of their basic medical insurance premiums;
(2) for employees between the ages of 35 to 44 years old, 1.5% of their basic medical insurance contribution base;
(3) employees over 45 years old, 1.7% of their basic medical insurance contribution base;
(4) retirees, 4% of the per capita contribution base of the active employees of the organization.
(5) Retirees of state-owned closed and bankrupt enterprises and older laid-off workers of state-owned enterprises who have made one-time single payment of medical fees for the rest of their lives are allocated 4% of the 60% of the city's social wage in the previous year to their individual accounts.
Individual accounts can pay for the following expenses:
1. the cost of medicines purchased at designated retail pharmacies, outpatient and emergency medical expenses;
2. for the purchase of commercial and accidental insurance;
3. medical expenses below the starting standard of the basic medical insurance co-ordination fund;
4. expenses exceeding the starting standard of the basic medical insurance co-ordination fund, which will be borne proportionally by the individual. standard, the individual shall bear the expenses payable by him/her according to the proportion.
5. If the personal account is insufficient to cover the expenses, the individual shall pay for them.
1. The main purpose of medical insurance card
1. The main purpose of medical insurance is to pay for outpatient treatment.
2. There are other uses for the card, which can be used to buy medicines (over-the-counter medicines), medical equipment, thermometers and blood pressure monitors at designated pharmacies.
Second, how to use the money in the medical card account
We all know that the employee health insurance is generally divided into individual account and integrated account, how to use these two respectively?
Individual accounts can pay for the following expenses:
1. the cost of purchasing medicines at designated retail pharmacies, outpatient and emergency medical expenses;
2. for the purchase of commercial insurance, accident insurance, etc.
3. medical expenses below the starting standard of the basic medical insurance co-ordination fund;
4. more than the starting standard of the basic medical insurance co-ordination fund. In the event that the individual account is insufficient to cover the expenses, the individual will pay for the expenses himself.
The co-ordinated account mainly pays for the following expenses:
1. medical expenses for hospitalization;
2. outpatient medical expenses for radiation treatment of malignant tumors, renal dialysis, and anti-rejection medication after renal transplantation;
3. medical expenses for the patients who are admitted to hospitalization after emergency rescue and are under hospitalization for the first seven days of their stay.
Three, the scope of reimbursement of medical insurance
1. The reimbursement of medical insurance card is limited to the medical expenses above the hospitalization caused by diseases and some accidents in the designated hospitals.
The reimbursement formula is: (total cost - threshold fee - out-of-pocket expenses - overspending) * (75 + age * 0.2)%, under normal circumstances, the actual reimbursement rate ranges from 20 to 60%.
Out-of-pocket expenses are not reimbursed, 80% of reimbursement is for Class B drugs, there is a limit on bed charges, and some examination and treatment fees as required are not reimbursed.
2. The reimbursement amount of the health insurance card is 4 times of the average salary of the local social workers (the cumulative value in 1 year).
3. The money in the health insurance card can be used to buy medicines at designated pharmacies and to pay for outpatient and emergency treatment, but it is not reimbursed because the money in the card is the money in the individual account of the health insurance.
4. Reimbursement for major medical insurance
After a participant suffers from a major illness, the part of the individual's out-of-pocket expenses incurred in the designated medical institutions of the city's medical insurance and in line with the city's medical insurance regulations are included in the scope of the payment of the residents' major medical insurance, and the funds of the major medical insurance are reimbursed by 50 percent.
That is, the amount of reimbursement = out-of-pocket expenses × 50%.