What treatment can be enjoyed by employee medical insurance, and what treatment can be enjoyed by em

Hello, the employee medical insurance is paid by the state to the employer, and we only need to bear a small part. Dad helps everyone talk about the treatment of employee medical insurance.

1. When the medical insurance for urban employees reaches the statutory retirement age, men can pay for 25 years, and women can enjoy life after 20 years. (Varies according to the actual policy of each city).

2. Medical insurance reimbursement: According to the provisions of the Social Insurance Law, the medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations.

The reimbursement rate of employee medical insurance is relatively high, usually 70%-90%. The reimbursement rate of medical insurance for general residents is 40%-80%.

3. There are two accounts for employee medical insurance: (1) one is the overall account, which is the account used to reimburse hospitalization medical expenses. (2) The second is the personal account, which can be used to pay for medical expenses other than the payment of the pooled account.

Daddy summary: Compared with resident medical insurance, employee medical insurance has greater advantages in many places, and it is generally recommended to pay employee medical insurance. However, it is not enough to have employee medical insurance, and it is recommended to supplement personal protection with commercial insurance.

1. Those who have paid for the employee medical insurance can see a doctor and buy drugs in designated medical institutions, and the diseases and drugs they buy meet the standards of the basic medical insurance drug catalog, diagnosis and treatment items, medical service facilities, as well as the medical expenses of emergency and rescue, and they can be paid from the basic medical insurance for employees according to the regulations.

2. There are two components of basic medical insurance for employees: overall planning and personal accounts. There is a minimum payment standard and a maximum payment limit, the minimum payment standard is about 10% of the average annual salary of local employees in principle, and the maximum payment limit is about 6 times the average annual salary of local employees in principle.

Medical expenses below the threshold shall be paid from the personal account or by the individual. The medical expenses above the minimum payment standard and below the maximum payment limit are mainly paid from the overall planning, and individuals also have to bear a certain percentage.

The five insurances are stipulated by the state that the company must pay, and the unit has no responsibility not to do it.

The most important role of medical insurance is to reimburse us for medical expenses, but what is the significance of medical insurance for us? Are there any changes to medical insurance in 2021? 》

So, what kind of treatment can employees enjoy in medical insurance?

Sickness benefits

Sickness benefit is also known as sick pay. If an employee is sick or injured not due to work-related injuries and ceases to work for more than one month, the salary shall be suspended, and the employer shall pay the employee a sickness allowance equivalent to a certain percentage of his or her salary according to the length of his or her length of service, which shall not be less than 80% of the local minimum wage standard.

Medical treatment

Employees can generally choose to seek medical treatment at designated hospitals that have signed a medical insurance contract with the social insurance agency. Its insurance treatment items mainly include: drug expenses within the specified range, prescribed examination fees and ** expenses, and prescribed standard hospitalization expenses.

Among them, the personal account of the employee is used to pay for small medical expenses, and the social pool** is used to pay for large medical expenses. In addition, when an employee supports a relative who is sick**, he or she is generally only given a certain percentage (generally 50%) of the medical expenses for certain items (such as medicine, surgery, etc.).

Treatment during the medical treatment period

Employees are entitled to medical insurance benefits, except for those who are completely incapacitated, only within the prescribed medical treatment period.

The length of the medical treatment period is determined according to the continuous length of service of the employee and the length of service of the unit, with the shortest not less than 3 months and the longest generally not more than 24 months; For diseases that are difficult to suffer, the medical treatment period may be appropriately extended after being submitted by a medical institution, applied by the person, and approved by the labor administrative department, but the extension period is up to 6 months.

Employee medical insurance can enjoy the treatment of general outpatient, inpatient, outpatient specific diseases, designated single diseases and personal accounts.

Want to know how to choose health insurance? See here: "Which is the best health insurance?" That's right! 》

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

In accordance with the regulations, employee medical insurance participants can enjoy the treatment of general outpatient, inpatient, outpatient specific diseases, designated single diseases and personal accounts.

Although there are multiple benefits for employee medical insurance, the coverage is not comprehensive after all, and we need to cooperate with commercial medical insurance to establish a sound medical security system. Let's take a look at which medical insurance is worth choosing: Which is the best? That's right! 》

The differences between resident medical insurance and employee medical insurance are mainly in the following three aspects:

1. Applicable people:

Medical Insurance for Urban Residents: The applicable population mainly includes minor residents, referring to primary and secondary school students (including vocational high schools, technical secondary schools, and technical school students), preschool children and other minor residents under the age of 18; Elderly residents refer to urban residents who are over the age of 60 for men and over 55 for women; and other unemployed adult urban residents.

Employee medical insurance: The applicable group is the employees of all urban employers, including employees of enterprises, government agencies, public institutions, social organizations, private non-enterprises and other units.

2. Payment method:

Medical insurance for urban residents: Individuals pay through the neighborhood committee or school (kindergarten) where they live, and at the same time, subsidies will be given on the basis of individual and family contributions. The standard of raising medical insurance for urban residents is much lower than that of medical insurance for urban employees, which is about 1 5 of the per capita financing amount of medical insurance for urban employees.

Employee medical insurance: urban employee medical insurance is paid by the unit according to a certain proportion of the total salary of the unit;

3. Reimbursement ratio:

Medical insurance for urban residents: reimbursement of hospitalization expenses and reimbursement of outpatient expenses for co-ordinated diseases. Because of the lower contribution rate, the treatment is also relatively low.

After deducting the expenses outside the scope, the part above the minimum payment line (the same as the medical insurance for urban employees) will be reimbursed at 55%, and the maximum cumulative reimbursement for each medical year is 30,000 yuan. If the outpatient expenses of the co-ordinated diseases are above the minimum payment line (300 yuan), they will be reimbursed at 50%.

Employee medical insurance: can enjoy the reimbursement of hospitalization expenses, the reimbursement of outpatient expenses of the overall disease, and the treatment of personal accounts used to pay for outpatient medical expenses, and its reimbursement ratio is higher than that of urban residents' medical insurance. After deducting the expenses outside the scope, the part above the minimum payment line to 5,000 yuan will be reimbursed at 75%; The part between 5,000 yuan and 10,000 yuan will be reimbursed at 80%; The part above 10,000 yuan will be reimbursed at 85%, and the retiree will be increased by 10%; Coordinate the reimbursement of outpatient expenses for diseases, 80% for active employees and 85% for retired employees.

From the above three differences, it can be seen that the effect of employee medical insurance protection is better.

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

The difference between the slag of resident medical insurance and employee medical insurance lies in the different medical insurance populations, different payment standards, different dust payment, different treatment standards, and different payment requirements

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

Hello, according to the question you said. The scope of payment of the medical insurance personal account mainly includes the basic medical expenses of Heshu outpatient clinic and Pushan Pai Peng Tong disease; Among the basic medical expenses for hospitalization, the medical expenses under the overall payment standard shall be determined by the individual, and the corresponding medical expenses above the minimum payment standard to the maximum limit, which shall be borne by the individual in proportion; Among the basic medical expenses of specific outpatient items, the medical expenses below the minimum payment standard of the overall **, and the corresponding medical expenses above the minimum payment standard to the maximum limit, the expenses that should be borne by the individual in proportion; The cost of purchasing drugs at designated retail pharmacies with a prescription.

Article 27 of the Social Insurance Law stipulates that individuals who participate in the basic medical insurance for employees and reach the statutory retirement age when the cumulative contributions reach the number of years specified by the state shall not pay the basic medical insurance premiums after retirement, and enjoy the basic medical insurance benefits in accordance with the provisions of the state; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state. Conditions for retirees to enjoy basic medical insurance benefits:

Retirees need to meet three conditions to enjoy basic medical insurance treatment according to national regulations: participate in basic medical insurance for employees, reach the statutory retirement age, and reach the cumulative payment for the number of years specified by the state. Employees of our city work in the employer and participate in the basic medical insurance for urban employees, flexible employment personnel to participate in the basic medical insurance for urban employees, meet the retirement conditions and the minimum payment period of basic medical insurance reaches 30 years for men, 25 years for women, after retirement according to the provisions of the basic medical insurance treatment, less than the minimum payment period of basic medical insurance, in the retirement procedures, can apply for a one-time payment.

Basic medical insurance treatment for retirees: The preferential treatment of employee medical insurance for retirees is reflected in three aspects: First, retirees do not pay basic medical insurance premiums and enjoy basic medical insurance benefits in accordance with national regulations; the second is to establish a personal account for basic medical insurance for retirees; The third is to take care of the proportion of medical expenses borne by retirees, which is mainly reflected in the halving of the out-of-pocket payment of some retirees in hospitalization.

Article 27 of the Social Insurance Law of the People's Republic of China Individuals who participate in the basic medical insurance for employees who have reached the statutory retirement age and have paid for a number of years specified by the state shall no longer pay basic medical insurance premiums after retirement and enjoy basic medical insurance benefits in accordance with national regulations; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state.