★Basic medical insurance
1, the basic medical insurance system is an important part of the social security system, is formulated by the government, employers and employees *** with the participation of a social insurance system. It determines the level of basic medical insurance for employees in accordance with the financial, employer and employee affordability, and is characterized by its broad, ****ancial and compulsory nature.
2. Basic medical insurance establishes individual accounts and a general fund. Basic medical insurance premiums are borne by both the organization and the employee***.
(1) The purpose of the individual medical account is to establish a self-accumulation mechanism for individual workers, to strengthen the workers' awareness of medical expenses and self-protection, so that when they are young and healthy, they can save up medical expenses for when they are old and sick, and to establish a self-restraining mechanism for the rational use of medical expenses and the prevention of waste.
(2) What the individual account can pay for
It can pay for outpatient and emergency medical expenses, and the cost of medicines purchased at designated pharmacies. The basic medical insurance fund starts to pay the standard amount, the proportion of hospitalization medical expenses above the starting standard to below the maximum payment limit that should be borne by the individual, as well as the medical expenses that need to be paid by the individual in the course of medical treatment. The savings in the individual account will be returned to the individual, and the overspending part will be taken care of by the individual himself/herself.
3. Individual's contribution salary
Individual's contribution salary is the basis for calculating individual's basic medical insurance premiums, in which the amount of individual's monthly contribution=individual's monthly contribution salary*individual's contribution ratio. In the future, with the development of the economy and the increase of the employees' salary income, the contribution rate of the unit and the employees can be adjusted appropriately.
(1) The portion of individual contributions shall be withheld by the unit from the individual's salary and credited in full to the individual's account, and a portion of the basic medical insurance premiums paid by the employing unit shall be credited to the individual's account according to different ratios:
1) 1 percent of the individual's contributory salary shall be transferred to the individual account for the employees below the age of 45 years old;?
②At the age of 45 years old (including 45 years old) employees by 2% of their own contributions to the salary;
③Retirees by 4.5% of their basic pension or retirement contributions in the previous year.
(2) At present, the city's basic medical insurance unit and individual contribution ratio
Unit contribution ratio individual contribution ratio
8%2%
For example: so-and-so's personal contribution salary in 2005 was 700 yuan/month, and the individual's monthly contribution to the basic medical insurance premiums = 700 * 2% = 14 yuan. The basic medical insurance premium to be paid by the employer is determined by 8% of the sum of all employees' contributory wages
4. How to use the Medical Insurance Handbook or IC card when seeking medical treatment
Participants should present the Medical Insurance Handbook when seeking medical treatment at designated medical institutions, and present the medical insurance IC card when taking medicines at outpatient clinics or purchasing medicines at designated retail pharmacies. Those who do not present their medical insurance handbook or IC card when seeking medical treatment or purchasing medicine will be treated as non-insured persons.
Medical insurance handbook and IC card are printed by the provincial social medical insurance center, which are used to prove the identity of the insured person, record and store the use of funds in the individual account, as well as show the information of the latest medical treatment and settlement of medical expenses.
When the handbook or card is damaged or lost, it should be lost or replaced at the provincial social medical insurance center in time with the ID card and the introduction letter of the unit.
(1) outpatient management procedures
①Participants with the "medical insurance manual" registration, consultation;
② eligible medical expenses within the limit of the individual account billing, the excess is paid in cash.
(2) in the designated medical institution hospitalization management procedures
① participants with the "handbook" registration, consultation, where eligible for hospitalization, fill out the "hospitalization application form", the designated medical institution agreed to the Office of the medical insurance, hospitalization procedures, retain the "handbook", prepaid deposit, hospitalization;
② end of treatment, the participants to check the hospital invoices, settle the amount of money that should be borne by the individual and the individual account limit. Settlement of medical expenses should be borne by the individual and out-of-pocket expenses; should be paid by the integrated fund of medical expenses, the municipal health insurance agency to settle directly with the designated medical institutions;
③ Discharge formalities, retrieve the "Handbook".
5, warm tips: when you visit the hospital, should be based on the condition of a reasonable choice of designated hospitals
When you are sick, it is recommended that you go to different levels of medical institutions according to the condition.
Generally speaking, small and medium-sized hospitals and community health service centers (stations) and other primary designated medical institutions to solve your common diseases, common diseases, diagnosis of chronic diseases of the treatment and post-surgery recovery period of rehabilitation. Diseases such as high blood pressure and colds can be treated directly at primary healthcare organizations. The efficacy of treating such conditions in primary care is the same, and has the advantages of convenience, timeliness, cost and time savings.
Large general hospitals and specialized hospitals are the main solution to the problem of diagnosis and treatment when you have a critical or difficult illness. To the large hospitals, there are advanced medical equipment, a full range of specialists in various disciplines, high level of diagnosis and treatment, physicians experienced in diagnosis and treatment of the comprehensive advantages, but the large hospitals do not pay much attention to outpatient general illnesses, and the patient to see the doctor waiting time is long, the individual out-of-pocket expenses are relatively high.
6, how to handle
①new staff
new employees signed the "labor contract", the new employee will be a copy of their ID card and a recent one-inch color photo to the departmental administrator, and then by the departmental administrator to the company's human resources director, the director of the human resources department to validate the specific labor company for processing.
② Resignation
After the resignation of the employee, the labor company to handle the suspension or transfer procedures. That is, when the insured person's work unit changes, the balance of the individual account can be transferred with it; do not have the conditions for transfer, can be sent to me in a lump sum.
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