What should I do if I repeatedly enroll in medical insurance, and what should I do if I repeatedly e

Due to the large number of people who are repeatedly insured by medical insurance in China, the National Social Security Bureau has also issued a series of regulations to solve the problem of duplicate insurance.

1. Participate in medical insurance for employees and residents at the same time

If a resident has participated in both employee medical insurance and resident medical insurance, and has participated in employee medical insurance for more than one year, only the employee medical insurance will be retained, and the resident medical insurance will be cancelled.

If the insured person is a flexible employee and has both employee and resident health insurance, only one of them will be retained.

2. Repeated participation in resident medical insurance

If a resident repeatedly participates in the resident medical insurance, that is, he or she has participated in the resident medical insurance in different places, only the insurance relationship of the place of permanent residence will be retained.

3. Students repeatedly participate in insurance

If the student repeatedly enrolls in medical insurance, only the student registration will be retained.

4. Repeatedly participate in employee medical insurance

If a resident repeatedly participates in the employee medical insurance, only the insurance relationship at the place of employment will be retained.

In the above duplication of insurance situations, while retaining an insurance relationship, the duplicate insurance relationship should also be terminated immediately.

China Medical News

On August 21, the data showed that the new rural cooperative cooperative system in the country is currently in the country.

Basic medical insurance for urban residents and basic medical insurance for urban employees.

More than 100 million people are repeatedly insured by the three major medical insurances, resulting in more than 20 billion yuan of ineffective financial subsidies every year, which significantly increases the unreasonable financial burden.

On the surface, repeated insurance is taking national medical insurance subsidies, but what needs to be clarified is that not all the 20 billion yuan of additional subsidies fall on the insured. The reason is very simple, financial subsidies.

It is medicines and medical resources, rather than giving money to the insured, and residents who do not see a doctor do not "get" subsidies, perhaps it is mainly local health authorities or medical institutions that take advantage.

Who is to blame for more than 100 million residents who repeatedly participate in medical insurance? The board can't be hit on the insured, first of all, there are too many types of medical insurance, which makes it difficult for the masses to understand. Nowadays, there are many types of medical insurance, enterprise employees have basic medical insurance, and urban residents have urban medical insurance.

In rural areas, there is "New Rural Cooperative Medical System" medical insurance, as well as serious illness medical insurance.

Medical insurance for migrant workers and college students.

It is difficult for many people to identify which medical insurance is more cost-effective and saves money to see a doctor. In addition, different types of medical insurance have different restrictions in terms of disease types and reimbursement shares, and the masses can only reluctantly prevent diseases from happening before they occur, giving up a small amount of money to participate in insurance repeatedly.

Second, the closure of medical insurance is to blame. For example, the "NCMS" medical insurance can only be seen in rural medical institutions, but it does not work in urban hospitals, and migrant workers who participate in the "NCMS" in their hometowns cannot take it away from working in other cities, so they can only participate in the local migrant workers' medical insurance.

Third, it is to blame the interests of the department. In some areas, medical insurance has become a "fat meat" of interests, who occupies more medical insurance resources, who can get more financial subsidies, some localities or departments compete for insurance resources, such as some rural areas, farmers have exceeded the voluntary principle, in a compulsory, "medical insurance" state. In this context, repeated insurance participation is naturally more beneficial to the ** department.

Fourth, blame multi-head management, information is not shared. For example, the current employee medical insurance and resident medical insurance.

The two departments are managed by the human resources and social security departments, while the "NCMS" medical insurance is managed by the health department, and the management methods of the two departments are different, and the information systems are not shared and connected, resulting in the problem of duplicate insurance participation among migrant workers and rural students studying in cities.

Duplicate insurance not only increases the ineffective financial subsidy, but also increases the burden of residents' contributions. To solve this problem, we need to take a two-pronged approach: first, integrate medical insurance resources, and realize the overall planning of medical insurance in urban and rural areas as soon as possible.

If the insured pays medical insurance in more than two places, it should be in accordance with the principle of "first transfer and then clearing", and the agency in the place of transfer is responsible for cleaning up according to the regulations. Go to the Social Security Bureau to reserve a place, return the duplicate payment**, and the medical insurance paid at the same time in both places, the time of non-duplication can be cumulatively calculated; The time of repeated payment is not cumulatively calculated, and you can apply for the corresponding refund procedures for the medical insurance of the duplicate time in one place.

In the case of duplicate participation in medical insurance, eligible units or individuals can apply for medical insurance refund, but in some cases they cannot be refunded.

1. No refund.

1) If you are insured in multiple units at the same time, if more than one unit pays medical insurance premiums for the insured at the same time, the premiums paid by the unit will not be refunded, and the personal accounts of the insured will be merged.

2) If you participate in both employee medical insurance and resident medical insurance, if you participate in employee medical insurance and medical insurance at the same time, the repeated premiums will not be refunded.

3) Before the municipal co-ordination, before the municipal-level co-ordination, if there is a situation of duplicate medical insurance payment in different co-ordination areas, the duplicate premium will not be refunded. If there are any other situations of duplicate insurance refund, the provincial medical security department will work with relevant departments to clarify the specific circumstances of refunds and non-refunds based on the actual local situation.

2. Refundable circumstances.

1) Before the start of the treatment period, if the insured person repeatedly participates in the employee medical insurance or resident medical insurance, and it is before the start of the treatment period, he or she can apply for a refund for the individual according to law while terminating the relevant resident medical insurance participation relationship.

2) After paying the employee medical insurance premium in a lump sum on an annual basis, the flexible employment personnel who participate in the employee medical insurance with the unit in the middle of the employment, resulting in the situation of duplicate participation in the medical insurance, and have paid the employee medical insurance premium in a lump sum on an annual basis, can apply for a refund of the premium paid by the midway employment with the unit's medical insurance in accordance with the law.

3) During the period of receiving unemployment insurance money, the unemployment insurance institution will pay medical insurance for the unemployed person during the period of receiving unemployment insurance money, and if the unemployed person participates in the employee medical insurance as an individual at this time, he can apply for a refund of the employee medical insurance premium paid by the individual during the period of repeated insurance.

Difference Between Medical Insurance and Social Security:

1. Medical insurance is a kind of social insurance, which includes medical insurance, and the scope of social security is more extensive;

2. The concept is different. Social insurance is a social and economic system that provides income or compensation to people who are incapacitated, temporarily unemployed, or have lost their jobs due to health reasons. Medicare is a type of insurance that compensates for the medical expenses caused by illness.

3. The role is different.

Legal basis: Article 2 of the Insurance Law of the People's Republic of China.

The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

The practice of duplicate enrollment in medical insurance is as follows:

1. If the same type of social security is paid repeatedly, the insured person can request the social security to be returned to him after checking the amount by the transportation and information office;

2. If it is a duplicate payment of different types of social security, the insured person can apply for merging it into one social security.

Medical insurance is non-refundable in the following cases:

1. If the insured person pays the medical insurance premium at the same time in more than two insured units, the medical insurance premium paid by the unit will not be refunded, and the personal account will be merged;

2. If the insured person participates in the employee medical insurance and resident medical insurance during the same period, the duplicate payment will not be refunded;

3. Before the announcement of the average salary of the previous year, the personnel who have completed the suspension of medical insurance or the transfer of the relationship by the unit for them will no longer be liquidated and refunded for their employees' medical insurance contributions and personal accounts after the announcement of the average salary.

Legal basisArticle 16 of the Social Insurance Law of the People's Republic of China.

Individuals who participate in the basic pension insurance and have paid contributions for 15 years when they reach the statutory retirement age shall receive the basic pension on a monthly basis.

Individuals who participate in the basic endowment insurance can pay for 15 years and receive the basic pension on a monthly basis if the cumulative contribution is less than 10 years when they reach the statutory retirement age; It can also be transferred to the new rural social endowment insurance or urban residents' social endowment insurance, and enjoy the corresponding endowment insurance benefits in accordance with the regulations.

Legal Analysis:1After the one-time payment of medical insurance premiums, the individual participating in the mu insurance personnel shall be eligible for the preferential medical insurance payment rate and financial subsidies after review, and if the insured personnel have paid according to the prescribed payment base and proportion, they can apply for a refund of the preferential treatment and subsidies they should enjoy.

2.If the payment is not made in accordance with the prescribed payment base and proportion, the refund amount shall be verified by the district and county medical insurance agency according to the payment standard of the district and county before the overall planning at the municipal level, and the refund application shall be submitted. After being reviewed by the Human Resources and Social Security Bureau and the Finance Bureau, it will be submitted to the Municipal Social Security Bureau for review.

The refund can only be made after approval by the Municipal Human Resources and Social Security Bureau and the Municipal Finance Bureau.

3.After the individual insured person pays the normal annual payment, he or she meets the preferential policies of medical insurance after the state and audit, but he or she becomes an insured employee of the unit or dies, he or she can be refunded according to the amount calculated by the preferential policies of medical insurance.

4.During the period of receiving unemployment insurance money, if an individual insured person has been insured and paid by the unemployment insurance agency for him, and at the same time participates in the employee medical insurance as an individual and makes duplicate contributions, he or she may apply for a refund of the fees paid by the individual during the duplicate period in the following year. If you are troublesome, you can find everyone to pay social security.

Legal basis: Social Insurance Law of the People's Republic of China

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in different places to facilitate the insured to enjoy basic medical insurance benefits.

If you are enrolled in the medical insurance repeatedly, you can go to the medical insurance center to apply for surrender by showing the payment receipt.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease. Through the payment of the employer and the individual, the establishment of medical insurance**, the medical insurance institutions will give them certain economic compensation after the medical expenses incurred by the medical expenses of the remaining insured personnel. The establishment and implementation of the basic medical insurance system gathers the economic strength of the unit and the members of the society, coupled with the best funding, which can enable the sick members of the society to obtain the necessary material help from the society, reduce the burden of medical expenses, and prevent the sick members of the society from becoming poor due to illness.

The inpatient medical expenses incurred by the insured residents in the designated medical institutions of the basic medical insurance in the overall planning area within the scope of the policy, the part above the minimum payment standard shall be paid by the urban and rural residents' medical insurance ** in proportion. Township health centers and community health service institutions shall not be less than 80%, county-level medical institutions shall not be less than 70%, and municipal-level medical institutions shall not be less than 60%. Each co-ordinating area shall reasonably determine the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance.

Insured residents are hospitalized in provincial-level designated medical institutions, and the minimum payment standard shall be determined according to about 10% of the average hospitalization cost of each provincial-level designated medical institution in the previous year and not less than 1,500 yuan, and the proportion of inpatient medical expenses within the policy shall not be less than 50%, and the specific payment standard shall be reasonably determined by the Provincial Department of Human Resources and Social Security in conjunction with the Provincial Department of Finance according to the operation of medical insurance for urban and rural residents in each overall area and the medical treatment of insured residents. Medical insurance for urban and rural residents** sets a high payment limit for hospitalization. In a settlement year, the cumulative maximum payment limit of basic medical insurance for urban and rural residents (excluding serious illness insurance for urban and rural residents) is 150,000 yuan.

Social Insurance Law of the People's Republic of China

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with law have the right to inquire about payment records and records of individual rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions.