The difference between provincial medical insurance and municipal medical insurance, and the differe

The differences between provincial and municipal medical insurance are as follows.

1. The reimbursement ratio is different.

The reimbursement ratio of provincial medical insurance is higher than that of municipal medical insurance.

2. The handling place is different.

The provincial medical insurance can only be the employees and files of the provincial units, which are kept in the provincial talent center and handled by the provincial pension co-ordination.

Municipal medical insurance can only be the employees and files of the municipal units, which are kept in the municipal talent center, and are handled by the municipal pension co-ordination.

3. Designated medical institutions are different.

Provincial medical insurance can be used for medical treatment and hospitalization in any hospital (participating in designated medical insurance hospitals).

Municipal medical insurance can generally only be used for medical treatment and hospitalization in municipal hospitals (hospitals that participate in designated medical insurance).

Both provincial and municipal medical insurance are paid according to the coefficient of wages, and the ratio of 1:1 is on the personal account, which is no difference.

The differences are:1Hospital Outpatient Clinic:

The provincial medical insurance uses 1,200 yuan (money within the scope of medical insurance) to start the overall planning, with 16% self-payment ratio for civil servants and 30% self-payment ratio for other units, which can be used; The city medical insurance uses 1,500 yuan to start the overall planning, and the 40% self-payment ratio can only be used up to 6,000 yuan.

2.Many drugs can be paid by the provincial medical insurance with 0 self-payment, and many drugs in the municipal medical insurance have a self-payment ratio.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

Hello, the difference between provincial medical insurance and municipal medical insurance mainly includes designated hospitals, reimbursement ratios and related handling.

1. In terms of designated hospitals, one is a provincial hospital and the other is a municipal hospital.

2. In terms of reimbursement ratio, the situation is different from place to place, and generally the reimbursement ratio of provincial medical insurance is higher than that of municipal medical insurance.

3. In terms of handling, the provincial medical insurance can only be handled by the employees and files of the provincial units in the provincial talent center and the provincial pension co-ordination; Municipal medical insurance can only be the employees and files of the municipal units, which are kept in the municipal talent center, and are handled by the municipal pension co-ordination. Provincial medical insurance - at the time of admission: patients with medical insurance can go through the social security registration procedures with their ID cards, and then go to the ward for hospitalization.

At the time of discharge: The doctor arranges for the patient to be discharged from the hospital, and goes to the hospitalization fee office to go through the discharge settlement procedures with the admission registration form and ID card. Then the hospitalization documents, charging documents, insured medical insurance cards and ID cards are set up in the medical insurance office of the hospital for on-site settlement, and the reimbursement conditions must meet the reimbursement conditions of the resident medical insurance, and the reimbursement ratio is based on the reimbursement level of the hospital, and the hospital has set up a starting point for reimbursement.

Policies vary from place to place. The reimbursement process for hospitalization of urban employees' medical insurance has been simplified, and patients do not need to go to the social security center for reimbursement, but can directly settle on the spot in the hospital.

Legal basis]: Article 23 of the Social Insurance Law.

Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state. Legal basis:

Social Insurance Law of the People's Republic of China Article 27 Individuals who participate in the basic medical insurance for employees who have reached the statutory retirement age and have paid contributions for the number of years specified by the State shall no longer pay basic medical insurance premiums after retirement, and shall enjoy basic medical insurance benefits in accordance with the provisions of the State. If it is not reached, it can be paid until the number of years specified by the state. Hope the above is helpful to you.

First, the handling place is different.

The provincial medical insurance and the municipal medical insurance are very different, and the provincial medical insurance needs to go to the provincial pension co-ordination agency or the provincial talent center to carry out the corresponding business handling work; The municipal medical insurance is handled in the municipal pension co-ordination agency or the municipal talent center.

Second, the designated medical institutions are different.

Provincial medical insurance can be used in any designated medical hospital in the same province for medical treatment and hospitalization; However, municipal medical insurance can generally only be treated and treated in municipal designated hospitals in the city. (The payment coefficient is paid in a 1:1 ratio between individuals and units, and the specific amount of payment by both parties depends on the specific location).

Third, the reimbursement ratio is different.

The situation is different in different places, the reimbursement ratio is different, but generally the reimbursement ratio of the provincial medical insurance is higher than the municipal medical insurance, for example, take the Shaanxi Provincial Medical Insurance and the Municipal Medical Insurance as an example, the provincial medical insurance is 80% reimbursement, and the municipal medical insurance is 70% reimbursement.

Fourth, which one is better.

Judging from the above differences, the provincial medical insurance is obviously superior, but it should be noted that the provincial medical insurance center only accepts the insurance of public institutions and high-quality units.

The difference between provincial medical insurance and municipal medical insurance:

The direct unit responsible for medical insurance is different: the provincial medical insurance is the medical insurance for the employees of the provincial unit, and the municipal medical insurance is the medical insurance responsible for the municipal unit;

The undertaking agency is different: the provincial medical insurance needs to go to the provincial pension co-ordination agency or the Minmu Provincial Talent Center for corresponding business handling; The municipal medical insurance needs to be handled in the municipal pension co-ordination agency or the municipal talent center.

There is a clear difference in the reimbursement ratio: generally speaking, the reimbursement ratio of municipal medical insurance is higher than that of provincial medical insurance. Taking Zhengzhou as an example, the insured persons of Zhengzhou urban employees are hospitalized, and the overall planning is in.

The proportion of payment in Class I, II and III designated medical institutions is %, and the proportion of personal burden is %; Retired insured persons are hospitalized as co-ordination**.

In the first, second and third categories of designated medical institutions, the proportion of file fraud payment is %, and the proportion of personal burden is %. In terms of provincial medical insurance, the reimbursement ratio for active and retired employees has been adjusted to 85% and 90% respectively. At the same time, the reimbursement standard for inpatient bed fees has also been increased from 11 yuan to 20 yuan.

The differences are as follows: The nature of the unit is different: Generally speaking, the units that pay the provincial medical insurance are provincial units: such as the Provincial Bureau of Statistics and the Provincial Development and Reform Commission. The scope of enterprises paying for medical insurance in the city is relatively wide, including foreign-funded enterprises, joint ventures, and private enterprises.

The reimbursement of the hospital is different: the scope of medical treatment of the provincial medical insurance is more extensive than that of the municipal medical insurance, and the municipal medical insurance can only be treated in the designated hospital of the city, and the provincial medical insurance can be treated in the hospital in the province without referral.

The reimbursement ratio is different: the reimbursement ratio of the provincial medical insurance is higher than that of the municipal medical insurance, and most of the municipal medical insurance is above 40%, while the provincial medical insurance usually has a higher payment standard.

What is the difference between the provincial medical insurance and the municipal medical insurance?, let's take a brief look at it below.

Clause. 1. The nature of the unit to be paid is different. If you want to understand the difference between provincial medical insurance and municipal medical insurance, you must figure out the unit that pays provincial medical insurance and municipal medical insurance.

Generally speaking, the units that pay for provincial medical insurance are provincial units, that is, units that are vertically managed by the province, such as: the Provincial Bureau of Statistics, the Provincial Development and Commission, the Provincial Economic Commission, the Provincial Ethnic Affairs Commission, the Provincial Population and Family Planning Commission, the Provincial Department of Education, etc., which have a special provincial medical insurance center to be responsible for medical insurance matters. Comparatively speaking, the scope of enterprises in the municipal medical insurance payment is relatively wide, and most of the foreign-funded enterprises, joint ventures, private enterprises, etc. are paid by the municipal medical insurance.

Clause. Second, the suitable designated hospitals are different. Generally speaking, the scope of medical treatment of provincial medical insurance is wider than that of municipal medical insurance, simply put, municipal medical insurance can only be treated in the designated hospital of the city, if you want to seek medical treatment across the city, you need to make a referral, etc., and the provincial medical insurance does not need to carry, as long as you are in the designated hospital in the province, you do not need to be referred.

Clause. Third, the reimbursement ratio is also different. Generally speaking, the reimbursement ratio of provincial medical insurance is higher than that of the city medical insurance, and generally speaking, the self-payment ratio of the provincial medical insurance (that is, the hospitalization expenses paid by oneself) will not exceed 30%, while most of the municipal medical insurance is above 40%.

Because the nature of the payment unit is different, the proportion of natural payment is not the same, generally speaking, the provincial medical insurance is paid according to the highest standard, and the municipal medical insurance is generally the lowest or middle proportion.