1. The fees to be paid are different. Compulsory medical insurance second-class individuals need to pay 2086 yuan, and third-class individuals need to pay 636 yuan.
2. Second gear and third gear enjoy different medical treatment.
3, the principle of medical treatment
Second-class insured persons: outpatients seek medical treatment in the binding community health center, inpatient departments seek medical treatment in any designated medical institutions in the city, and outpatients seek medical treatment in designated medical institutions for serious illness.
Third-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.
Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation.
Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. Therefore, the medical insurance system is usually enforced by national legislation and a fund system is established. The expenses are paid jointly by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the employees.
What is the role of medical insurance for urban and rural residents?
The insured person is seriously ill, so medical insurance for urban and rural residents can reduce everyone's economic burden to a certain extent. The insured is in good health, but the premium can be used to help others in need. At the same time, everyone will not have too many worries after participating in the medical insurance for urban and rural residents, because if they go to the hospital for treatment, they can be reimbursed.
Second, the basic principles of medical insurance for urban and rural residents
1. Overall planning and coordinated development. It is necessary to incorporate the medical insurance system for urban and rural residents into the development of the universal medical insurance system and deepen the overall situation of medical reform, make overall arrangements and rational planning, highlight the linkage between medical insurance, medical care and medicine, strengthen the connection between basic medical insurance, serious illness insurance, medical assistance, disease emergency assistance and commercial health insurance, and enhance the systematicness, integrity and synergy of the system;
2, based on the basic, to ensure fairness. It is necessary to accurately locate and scientifically design, fully consider and gradually narrow the gap between urban and rural areas and regional differences according to the level of economic and social development, the burden of urban and rural residents and the ability to bear funds, ensure that urban and rural residents enjoy basic medical insurance benefits fairly, and realize the sustainable development of the medical insurance system for urban and rural residents;
3, according to local conditions, in an orderly manner. It is necessary to comprehensively analyze and judge according to the actual situation, carefully formulate the implementation plan, strengthen the connection before and after integration, ensure the smooth continuation and orderly transition of the work, ensure that the basic medical insurance benefits of the people are not affected, and ensure the safety of the medical insurance fund and the smooth operation of the system;
4. Innovate mechanisms to improve efficiency. It is necessary to adhere to the separation of management and operation, implement government responsibilities, improve the management and operation mechanism, further promote the reform of payment methods, and improve the efficiency of the use of medical insurance funds and the efficiency of management services. Give full play to the role of market mechanism and mobilize social forces to participate in basic medical insurance services.
Third, the scope of reimbursement
The following expenses incurred by the insured in designated medical institutions and retail pharmacies can be included in the reimbursement scope of the basic medical insurance fund for urban and rural residents:
1. Medical expenses for outpatient (emergency) consultation in a tertiary first-class hospital (community health service center).
2. Hospitalization medical expenses.
3. Medical expenses within 7 days before emergency observation and hospitalization.
4, in line with the provisions of the urban and rural residents outpatient special disease medical expenses.
5, the establishment of family sickbed hair
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.