Employees in new forms of employment, individual industrial and commercial households and their employees who have reached the legal age of employment and rely on the Internet platform for employment and have not established labor relations with new business platform enterprises, part-time employees who have not participated in the basic medical insurance for employees in the employing unit, individual (free) employees, flexible employees who have participated in the basic medical insurance for urban and rural residents, and other flexible employees; Retirees from former state-owned enterprises who have gone through retirement procedures and have not participated in the basic medical insurance for urban workers may voluntarily participate in the medical insurance for employees in their personal capacity.
2. Where and when can flexible employees participate in employee medical insurance-related businesses?
(a) flexible employment personnel choose to participate in medical insurance for employees, directly to the medical insurance agencies in counties and cities of our city for insurance procedures; The insured person can also go through the formalities of enrollment through file custody (agency) (at present, the third-party human resources company custody can choose to continue to participate in the original medical insurance agency with the company as the unit, or choose the medical insurance agency in each county and city independently). After the insured person completes the registration, he can pay the medical insurance premium through the tax hall, WeChat, China UnionPay Express and other channels.
(2) Every year 165438+ 10/0 to 65438+February 3 1 is the centralized payment period for flexible employees to participate in the basic medical insurance for urban workers in the next year. The insurance payment in 2022 has recently started. For details, please consult the medical insurance agencies in counties and districts.
3. What is the payment base and proportion of flexible employees participating in employee medical insurance?
(1) payment base. Flexible employment personnel to participate in the basic medical insurance for urban workers according to the city's last year, 60% of the average wage of employees in full-bore urban units as the payment base. The payment base is adjusted by the municipal medical security department in conjunction with the statistics, human resources and social security departments according to the economic and social development and fund operation.
(2) payment ratio. Flexible employment personnel to participate in the basic medical insurance for urban workers to pay according to the payment base. Reducing the basic medical insurance rate of employees by stages (reducing 2%) is suitable for flexible employees.
It should be pointed out that flexible employees who participate in the basic medical insurance for urban workers need to participate in large medical insurance at the same time. The payment base of large medical insurance is 8 yuan per person per month (including retirees), which is paid at the same time as the basic medical insurance premium.
4. What information do flexible employees need to submit to participate in employee medical insurance for the first time?
(1) Flexible employees who have reached the legal employment age should provide:
My valid ID card and household registration book; Flexible employees who are not registered in our city need to provide: my valid ID card and my residence permit in our city (including residence permit for Hong Kong, Macao and Taiwan residents).
(two) in line with the scope of insurance did not participate in the basic medical insurance for urban workers or interrupt the original state-owned enterprise retirees to provide:
1. Copy of my valid ID card and retirement approval materials, and affix the official seal of the issuing department. Unable to query the examination and approval materials for retirement, the archival custody institution shall provide a copy of the archival materials (such as the employment political examination form, the regularization grading form, the admission notice, the salary adjustment form, etc.). ) can prove his work experience in state-owned enterprises, and affix the official seal of the department or the seal of file management.
2 medical insurance payment period related materials:
1 Relevant information about the actual payment period. Certificate of participation in the actual payment period of the basic medical insurance for urban workers issued by the medical insurance agencies at all levels in this Municipality (if the payment period can be found in the current medical insurance system, it is not required).
2 as the relevant information of the payment period. June 2000 5438+1 October1Relevant materials on the actual working years (continuous working years) in state organs, institutions, people's organizations and state-owned and state-holding enterprises before the implementation of the reform of the basic medical insurance system for urban employees in our city; Length of military service related materials of demobilized military cadres and retirees; Proof of the number of years of medical insurance for urban and rural residents within the administrative area of our city; Proof of the payment period for participating in the basic medical insurance for urban workers in different places outside the overall planning area.
Five, how to calculate the amount of flexible employees to participate in the medical insurance for urban workers in our city?
(a) the amount of flexible employment for the first time.
1. Payable amount of flexible employees within the legal employment age = monthly payment base × the proportion of payment will be reduced in stages) × months (payment month to 65438+February)+monthly payment base of large medical insurance × months (payment month to 65438+February).
2. The amount to be paid by the flexible employees who have gone through retirement procedures within the insured scope.
(1) Choose to continue to pay according to the amount payable by employees = monthly payment base × payment ratio needs to be reduced in stages) × number of months (payment month to 65438+February)+monthly payment base of large medical insurance × number of months (payment month to 65438+February).
(2) Select the payment ratio (applicable to phased reduction) × months (the remaining months required to reach the minimum payment period) with the amount payable by the one-time payment personnel = monthly payment base ×8%.
(two) approved the amount payable by the normal renewal personnel during the centralized payment period.
1. Amount payable by flexible employees (medical insurance employees) = monthly payment base × payment ratio × 12 (month)+large medical insurance premium 96 yuan.
2 flexible employees (medical insurance retirees) should pay the amount = large medical insurance 96 yuan.
Six, flexible employment personnel to participate in medical insurance for employees in our city how to enjoy medical insurance benefits for employees?
(1) The first insured
Flexible employees who participate in medical insurance for urban workers for the first time are given a waiting period of 3 months. That is, within 3 months from the date of payment, you will not enjoy medical insurance benefits, but you can use your personal account to seek medical treatment and purchase medicines; If you continue to pay medical insurance premiums after 3 months, you can enjoy medical insurance benefits according to the provisions of the basic medical insurance for urban workers in our city.
(2) Continuous insurance
Flexible employees who continue to participate in the insurance do not set a waiting period and enjoy medical insurance benefits for urban workers in our city from the date of payment. The following situations are regarded as continuous insurance:
1. Those who have participated in the medical insurance for urban workers will be transferred to the basic medical insurance for urban workers in our city as flexible employees within three months after the interruption of payment, and make up the medical insurance premium during the interruption;
2. For two consecutive years (including two years) or more, the insured who participated in the basic medical insurance in our city changed from the medical insurance for urban and rural residents to the medical insurance for flexible employees due to the change of personal employment status, and the payment was interrupted for no more than three months, and the medical insurance premium was paid during the interruption period;
3 employees who have participated in medical insurance for flexible employees will resume normal payment within three months after the interruption of payment, and make up the medical insurance premium during the interruption.
(3) Personal account
After the flexible employment personnel pay the medical insurance premium, the on-the-job personnel allocate personal account funds according to 2% of the payment base; Enjoy medical insurance retirement benefits, according to the payment base of 5% personal account funds allocated. The proportion of individual account allocation will be adjusted according to factors such as policy adjustment and fund operation.
(4) Interrupting participation in insurance
Flexible employees shall not interrupt their participation in the basic medical insurance for urban workers during the period. In case of intermittent insurance, it shall be treated as the first insurance. During the interruption of insurance, personal accounts can continue to be used. In any of the following circumstances, it shall be regarded as insurance interruption:
1. Those who have participated in the basic medical insurance for urban workers will be transferred to the basic medical insurance for urban flexible employees after the payment has been suspended for more than three months;
2 for more than two consecutive years (including two years) to participate in the basic medical insurance for urban and rural residents in our city and then transferred to the basic medical insurance for urban flexible employees, with an interruption period of more than three months;
3. Failing to declare and pay the basic medical insurance premium for urban workers within the specified time;
4 other circumstances identified by the medical insurance department to interrupt the insurance.
Seven, to participate in the medical insurance for urban workers in our city, how can female flexible employees enjoy maternity allowance?
The medical insurance of female flexible employees is in a normal state when they give birth. Before delivery (including delivery month), if maternity insurance 12 months has been paid continuously, the maternity allowance shall be paid by the maternity insurance fund; If the continuous payment before delivery is less than 12 months, and the continuous payment after delivery (including delivery month) is over 12 months, the maternity allowance will be supplemented by the maternity insurance fund. If the medical insurance of female flexible employees is abnormal or the payment of maternity insurance does not meet the relevant provisions, the maternity allowance fund will not pay.
Eight, how to determine the payment period for flexible employees to participate in medical insurance for urban workers?
Payment period consists of actual payment period and deemed payment period.
(a) the actual payment period refers to the actual number of years after the implementation of the reform of the basic medical insurance system for urban employees in our city on June 65438+ 10/day, 2000, when employers and employees participated in the basic medical insurance for urban employees in our city according to regulations;
(II) The deemed payment period refers to the payment period of basic medical insurance for migrant workers in length of military service, a state organ, institution, people's organization, state-owned and state-holding enterprises, and demobilized military cadres and retirees before the implementation of the basic medical insurance system for urban workers in our city.
Nine, how to determine the medical insurance benefits for retirees with flexible employment?
After flexible employees reach the statutory retirement age (60 years for men and 55 years for women, as otherwise stipulated by the state), the minimum payment period is 30 years for men and 25 years for women, and the actual payment period is 15 years. After the retirement of the medical insurance agency is confirmed, the basic medical insurance premium will no longer be paid, but it needs to be declared on an annual basis and continue to pay a large amount of medical insurance premium to enjoy the basic medical insurance benefits for retirees.
When the statutory retirement age is reached, if the payment period does not meet the requirements of the basic medical insurance for urban workers in our city, the on-the-job personnel will continue to pay or pay in one lump sum to reach the prescribed payment period, and they can enjoy the basic medical insurance benefits for retirees after the medical insurance agency handles the retirement procedures. The one-time payment base is calculated according to the annual payment base, and the rate is calculated at 8% (applicable to phased reduction). No personal account, no large medical insurance.
Take an example.
Since the average salary of employees in full-caliber urban units in our city in 20021year has not been announced, the monthly payment base of flexible employees is RMB based on the average salary of employees in full-caliber urban units in 2020.
Example 1. Wang, male, 35 years old. On April 1 2022, I participated in employee medical insurance for the first time as a flexible employee.
In 2022, it is necessary to pay 9 months' employee medical insurance premium and large medical insurance premium in one lump sum, and the payment amount is ×(×9+8×9= yuan). Personal account transfer ×2%×9=643 (RMB).
Example 2. Li, male, aged 65, was a retired employee of a former state-owned enterprise. 1980 joined the work, retired on 20 17, participated in the medical insurance for employees in our city in 200 1 -2005, and participated in the basic medical insurance for urban and rural residents in our city from 2006 to 2022, on April 652, 2022.
Li's payment period is calculated as follows: 1 as the payment period, in which he has worked for 20 years before 2000 (1980 to 1999) and participated in the medical insurance for urban and rural residents in our city for 5 years (converted from 2006 to 2022, and the insured residents are 1 after 3 years), *. 2 The actual payment period is 5 years (200 1 to 2005). Li's actual payment period is still 10 years short of the standard for recognizing medical insurance retirees. According to the on-the-job personnel, they should continue to pay or pay in a lump sum to reach the prescribed payment period, and they can enjoy the basic medical insurance benefits for retirees after being recognized by the medical insurance agency for retirement.
If paid by an on-the-job employee:
Still continue to pay according to the on-the-job personnel. In 2022, it is necessary to pay 9 months' employee medical insurance premium and large medical insurance premium in one lump sum, and the payment amount is ×(×9+8×9= yuan). Personal account transfer in 2022 ×2%×9=643 yuan. Then calculate the payment amount according to the annual payment base and payment ratio. Enjoy the medical insurance benefits of the on-the-job personnel before the medical insurance retirement recognition.
If it is a one-time payment:
The basic medical insurance premium of 10 years shall be paid in one lump sum according to the current payment base and payment amount, and the payment amount is ×(8%-2%)× 120= yuan); The large medical insurance premium to be paid in 2022 is: 8×9=72 yuan. Personal account transfer in 2022 ×5%×9= yuan). After that, you need to declare and continue to pay a large amount of medical insurance premium (8× 12=96 yuan) every year to enjoy the basic medical insurance benefits for retirees.
Tips:
1. During the epidemic prevention and control period, in order to reduce the gathering of people, please contact the medical insurance agency in the insured area through the business consultation hotline in advance to find out the business handling situation.
2. Those who have participated in the basic medical insurance for urban and rural residents need to participate in the medical insurance for urban employees in our city as flexible employees, and must go through the medical insurance procedures for employees after the surrender of the medical insurance for urban and rural residents, and complete the settlement of hospitalization and outpatient expenses for chronic diseases and special diseases before surrender. Repeated participation in insurance is prohibited.
3. Please carefully verify the valid ID number of the first insured person, so as not to affect your enjoyment of benefits; And keep a valid contact number in order to receive relevant information.