Questions about medical insurance premiums in Shanghai please 3Q

What is medical insurance? Medical insurance is a type of insurance that compensates for the medical costs associated with illness. Like other types of insurance, medical insurance is a contractual way to collect medical insurance premiums in advance from people threatened by illness and to establish a medical insurance fund; when the insured person falls ill and goes to a medical institution and incurs medical expenses, the medical insurance organization will give a certain amount of financial compensation. Therefore, medical insurance also has two major functions of insurance: risk transfer and compensation transfer. That is to say, the economic loss caused by the risk of disease in an individual is distributed to all the members who are threatened by the same risk, and the centralized health insurance fund is used to compensate for the economic loss caused by the disease. What is basic medical care? The goal of the reform of the employees' medical insurance system is to gradually make basic medical care available to all workers in cities and towns. "Basic medical care" can be defined as medical services that meet the necessary medical needs of the vast majority of insured workers, that medical service organizations can provide using appropriate technology, and that the medical insurance fund is able to pay for. "Basic medical care" is a relative category, with a phased, geographical and rolling nature, and its level of expenditure must be balanced with the level of health insurance financing. Basic medical care can be defined in terms of basic diagnostic and treatment techniques, basic medicines, basic facilities, and basic payment costs. How do individuals pay basic medical insurance premiums? According to the national medical insurance policy, individuals pay 2% of their salary income as basic medical insurance premiums, and the proportion of individual contributions will be adjusted upward appropriately according to the economic development. The medical insurance premiums to be paid by an individual are paid by his/her employer from his/her salary, but the premiums for self-employed urban workers are to be paid by the individual himself/herself. What is the medical insurance program? The major disease co-ordination is a mode of medical insurance in China, due to the limitations, it can only be achieved at the municipal level at present, and there are different approaches to this system in different places, for example, the major disease co-ordination in Beijing, and the hospitalization medical insurance co-ordination in Shanghai; however, they are all formulated in accordance with the principle of "triage for minor illnesses, and co-ordination for major illnesses", i.e., they stipulate a starting line from a few hundred yuan to a few thousand yuan. However, they all follow the principle of "triage for minor illnesses and co-ordination for major illnesses", i.e. a starting line is set, ranging from a few hundred to a few thousand yuan, depending on the local affordability and level of medical treatment. What are the costs of basic medical insurance medical service facilities? Basic medical insurance medical service facility fees mainly include hospitalization bed fees and outpatient (emergency) observation bed fees. According to the regulations of the price department of each province (city and district), the hospitalization bed fee and outpatient (emergency) observation bed fee mainly include three types of costs: first, the cost of basic ward supplies such as beds, mattresses, nightstands, chairs, mosquito nets, quilts, bedsheets, hot water bottles, washbasins (buckets), etc.; second, the cost of in-hospital transportation supplies such as stretchers and carts, etc.; and third, the cost of water and electricity, etc. The basic medical insurance fund pays for these costs. The basic medical insurance fund does not pay for these costs separately, and the designated medical institutions are not allowed to charge the insured persons separately. What kinds of living services and service facilities are not covered by the basic medical insurance? The costs of living services and service facilities that are not paid by the basic medical insurance fund mainly include five categories: firstly, the transportation fee for consultation (referral) and the emergency vehicle fee; secondly, the air-conditioning fee, the television fee, the fee for the baby's warming box, the fee for the food warming box, the fee for the electric stove, the fee for the refrigerator and the fee for compensation for damage to the public property; thirdly, the fee for the accompanying nurse, the fee for the nurse's worker, the fee for the cleansing and the fee for decocting medicines for the outpatient clinic; fourthly, the catering fee; and fifthly, the fee for the recreation and entertainment activities as well as the fee for the other Special living service expenses. The reason why the above living service items and service facilities are not payable is that some of these items are not necessary for diagnosis, treatment and care, such as TV, telephone, refrigerator, etc., and some are necessary but are the responsibility of the individual or unit, such as the transportation fee for medical consultation, the emergency vehicle fee, and the meal fee. Due to the great differences in living environments around the world, some items of medical services and facilities may not be necessary in some places, but are necessary in others, such as heating costs, which are necessary in the cold regions of the north. Whether such medical service facilities are included in the scope of payment of the basic medical insurance fund, the labor security administrative departments of each province (autonomous region and city) may stipulate their own rules in the light of the level of local economic development and the affordability of the basic medical insurance fund. Principles of Basic Medical Insurance Payment What are the principles according to which the basic medical insurance pays for medicines? Expenses incurred for the use of drugs on the "Class B List" shall be paid by the employee at a certain percentage of the employee's own expense and then according to the standards stipulated by the basic medical insurance. The basic medical insurance fund does not pay for expenses incurred for the use of Chinese herbal medicinal tablets if they are included in the drug list, and pays for them according to the standards stipulated by the basic medical insurance if they are not included in the drug list. For example, the starting payment standard of a coordinated area is 800 yuan, the maximum payment limit is 25,000 yuan, the proportion of individual's burden within the scope of payment of the coordinated fund is 10%, and the individual first pays 20% of the Class B drugs out of his own pocket. Now suppose that an employee in the city incurs 30,000 yuan in medical expenses for a hospitalization, of which 10,000 yuan is for medicines, 6,000 yuan is for the use of Class A medicines, 3,000 yuan is for the use of Class B medicines, and 1,000 yuan is for the use of medicines that are not included in the Catalogue of Medicines for Basic Medical Insurance. The employee's medical expenses will be paid as follows: 1. The employee's first personal out-of-pocket payment for Class B drugs will be: 3,000 × 20% = 600 yuan; the out-of-pocket payment for drugs not included in the Basic Medical Insurance Drug List will be: 1,000 yuan. 2. 6,000 yuan for Class A drugs and 2,200 yuan for Class B drugs will be included in the overall plan, along with the remaining 2,200 yuan and other medical expenses, and will be covered by the Basic Medical Insurance Fund. The remaining 2,200 yuan after the individual's out-of-pocket payment for Class A drugs (6,000 yuan) and Class B drugs (28,400 yuan), together with other medical expenses, are included in the scope of payment of the integrated fund, and are paid in accordance with the provisions of the basic medical insurance, and the expenses above the starting point amount to 27,600 yuan, which are paid by the integrated fund according to the following examples According to the above calculation, of the 30,000 yuan of hospitalization medical expenses incurred by the employee, the total amount of individual out-of-pocket payment and personal account payment is: 1000+600+800+2760=5160 yuan, and the payment from the integrated fund is 24840 yuan.