1. The basic medical insurance system is an important part of the social security system, which is a social insurance system formulated by the government and participated by employers and employees***. 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 for their old age when they are sick, and to set up a self-restraining mechanism for the rational use of medical expenses and the prevention of wastage.
(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 individual to pay part of the unit from their wages withheld, and the full amount of the individual account, the employer to pay part of the basic medical insurance premiums in different proportions of the individual account:
① 45 years of age or less of the workers by 1% of their own contributions to the wage;?
② Employees over 45 years old (including 45 years old) are credited with 2% of their paid wages;
③ Retirees are credited with 4.5% of their last year's basic pension or retirement contributions.
(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 individual contribution salary in 2005 was 700 yuan/month, and the individual's monthly payment of 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 getting medicines from 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 diagnosing and treating you in the event of a critical or difficult illness. To large hospitals, there are advanced medical equipment, a full range of specialists, high diagnostic and treatment level, experienced physicians, but large hospitals do not pay much attention to outpatient general illnesses, and patients wait a long time to see a doctor, the individual out-of-pocket expenses are relatively high.
6, how to handle
① new staff
new employees signed the "labor contract", the new employee will be a copy of my 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 labor company for specific processing.
② Resignation
After the resignation of the employee, the labor company unified for the suspension or transfer procedures. That is, when the insured person's work unit changes, the balance of the personal account can be transferred along with it; if the conditions for transfer are not met, it can be sent to the person in a lump sum.