The difference between the first account and the second account in the basic medical insurance 5

There is also a difference in the proportion of reimbursement.

Combination of unified accounts: China's basic endowment insurance implements the "combination of social pooling and personal accounts", which is combined with China's basic national conditions, drawing on the experience and lessons of international social insurance development, combining the advantages of social pooling with the advantages of personal accounts, and creating a pension insurance system with Chinese characteristics.

Single and model construction co-ordination: all the medical insurance premiums paid by flexible employees are used as co-ordination ** to pay for the hospitalization medical expenses of the insured, and the medical insurance agency does not establish a personal medical account for the insured (referred to as "single construction and unified code bumping").

The differences between the two are as follows:

First, the basic meaning is different.

1. The unified account combined with the security model is usually called "basic medical insurance".

2. The single construction of the overall security model, usually called "hospitalization insurance".

2. The difference between establishing a personal account.

1. Combination of unified accounts: the hospital establishes a personal account for each person.

2. Single-construction co-ordination: The hospital will not establish a personal account for each person.

3. The difference between facing the crowd.

1. The combination of unified accounts refers to the implementation of China's basic endowment insurance "combination of social pooling and personal accounts", which combines the advantages of social pooling with the advantages of personal accounts, and is oriented to all people.

2. The state-owned and urban large collective enterprises within the scope of the basic medical insurance for urban employees can apply to participate in the single-construction co-ordination and meet the conditions of extremely poor enterprises.

Fourth, the payment mode is different.

1. The combination of unified accounts is that enterprises bear 20% and individuals bear 8% in the process of pension insurance payment.

2. The basic medical insurance for urban employees shall be paid every month according to the total salary of the in-service employees of the unit in the previous year, and the individual employees shall not pay.

Fifth, the medical program is different.

1. The insured personnel who are individually co-ordinated can make ** according to their condition normally.

2. When the insured personnel who are hospitalized due to illness and need to carry out specific outpatient project diagnosis and treatment, special examination and special treatment due to illness, they will enjoy the basic medical insurance overall payment treatment in accordance with the "Interim Provisions on Basic Medical Insurance for Urban Employees".

Sixth, the basic unit of accounting is different.

1. The combination of unified accounts is based on the industrial activity unit as the basic accounting unit.

2. The independent accounting unit is used as the basic accounting unit.

Dear, hello, 1. The insurance rate is different Under the new measures, the transition period from December 2021 to December 31, 2024 is the transition period, during which the rate has been reduced, 2. The treatment is different The personal account is different: the unified account is combined with the employee medical insurance participants to establish a personal attack account, while the single construction and overall planning does not have a personal account. The proportion of payment for inpatient co-ordination treatment is different3, the proportion of payment for general outpatient co-ordination treatment is different, and the maximum payment limit for general outpatient co-ordination treatment is different Combination of unified accounts:

The maximum payment limit for the overall treatment of ordinary outpatient clinics is the multiple of the average annual salary of the city's employees in the previous year Single construction co-ordination: the times of the average annual salary of employees in the city in the previous year 5. 6. The maximum payment limit of the treatment year is different and the unified account is combined:

If the payment period is less than 1 year, the annual maximum payment limit is 4 times the average salary of the employees in the previous year The payment period is greater than or equal to 1 year (including retirement), and the annual maximum payment limit is 12 times the average salary of the employees in the previous year in the city Separate construction co-ordination: if the payment period is less than 1 year, the annual maximum payment limit is 2 times the average salary of the employees in the previous year The payment period is greater than or equal to 1 year (including retirement), and the annual maximum payment limit is 8 times the average salary of the employees in the previous year in the city.

Summary. 1. Financial supervisor: The medical insurance unified account model is supervised by the provincial financial department, implemented by the provincial social security department, and the medical institution will reimburse the expenses to the provincial financial department after charging, and the provincial financial department is responsible for the overall arrangement of reimbursement.

The single-construction co-ordination model is supervised by the local finance department and implemented by the local social security department, and the medical institution will reimburse the expenses to the local finance department after charging, and the local finance department is responsible for the overall arrangement of reimbursement. 2. Reimbursement standard: The reimbursement standard of the provincial medical insurance policy is adopted in the medical insurance unified account model, and the reimbursement standard is limited by the budget of the financial department, and the reimbursement payment method may not be able to meet the needs of patients.

The reimbursement standard is limited by the budget of the local financial department, and the reimbursement payment method can be more flexible and better meet the needs of patients. 3. Reimbursement expenses: The reimbursement expenses of the medical insurance unified account model are paid by the provincial financial department, and the reimbursement costs are less.

The reimbursement cost of the single-construction co-ordination model is paid by the local financial department, and the reimbursement cost can be larger, which can better meet the medical needs of patients.

1. Financial supervisor: The medical insurance unified account model is supervised by the provincial financial department, implemented by the provincial social security department, and the medical institution will reimburse the expenses to the provincial financial department after charging, and the provincial financial department is responsible for the overall arrangement of reimbursement. The single-construction co-ordination model is supervised by the local finance department and implemented by the local social security department, and the medical institution will reimburse the expenses to the local finance department after charging, and the local finance department is responsible for the overall arrangement of reimbursement.

2. Reimbursement standard: The reimbursement standard of the provincial medical insurance policy is adopted in the medical insurance unified account model, and the reimbursement standard is limited by the budget of the financial department, and the reimbursement payment method may not be able to meet the needs of patients. The single-construction co-ordination model adopts the local policy reimbursement standard, and the reimbursement standard is limited by the budget of the local financial department, and the reimbursement payment method can be more flexible and more able to meet the needs of patients.

3. Reimbursement expenses: The reimbursement expenses of the medical insurance unified account model are paid by the provincial financial department, and the reimbursement costs are less. The reimbursement cost of the single-construction co-ordination model is paid by the local financial department, and the reimbursement cost can be larger, which can better meet the medical needs of patients.