Why do you want to participate in medical insurance? Is it a loss that payment is useless?
Each of us is faced with uncertain disease risks, and medical insurance is used to prevent and resolve the risk of medical expenses. The basic principle is mutual assistance. Healthy people help sick people. Everyone puts a small amount of money together and makes a big pool of funds for those in need, that is, "I do it for everyone and everyone does it for me". Just because you haven't used health insurance before doesn't mean you won't use it in the future. As long as you participate in medical insurance and need money when you are sick, you can get medical insurance protection with the money in this pool.
Some people, by virtue of their youth, feel that they are in good health and do not need to participate in medical insurance, which may cause huge losses. For example, the contractor Xiao Wang refused to participate in medical insurance and got cancer last year. As a result, he borrowed money at his own expense and paid back more than 200 thousand. Afterwards, he calculated that if he participated in medical insurance, he might only need to pay tens of thousands of dollars, and he regretted it. So there is absolutely no loss in participating in medical insurance.
Three functions of residents' medical insurance:
1, outpatient medical treatment
2. Hospitalization
3. Increase the reimbursement rate of commercial medical insurance.
Residents' medical insurance dry goods information:
Payment amount: 280/ year/person
Insurance period: 202 1 1 10/to 202 11February 3 1.
Insurance liability: mainly including outpatient medical treatment and hospitalization medical treatment;
General outpatient service: it mainly includes medical expenses and drug expenses in the medical insurance catalogue. Outpatient prescribed diseases: including malignant tumor, organ transplantation, hematopoietic stem cell transplantation and other 32 diseases.
Critical illness clinic: including end-stage renal disease, common high-risk cancer, hemophilia and other 40 serious diseases.
The specific reimbursement rules for residents' medical insurance are as follows:
If it is a general outpatient clinic, you can be reimbursed in proportion if you buy medicine in a prescribed hospital. But the annual quota is only 150 yuan. The part exceeding 150 yuan shall be borne by yourself. If it is a chronic or serious illness clinic, the reimbursement rate is higher than that of a general clinic, but different diseases also have corresponding limits, ranging from several hundred yuan to several thousand yuan per month.
For example, Xiao went to a 3A hospital for a cold check-up, took some medicine, spent 400 yuan, and was reimbursed according to the reimbursement rate of 55%. Then, Xiao A can be reimbursed 400 * 55% = 220 yuan, but the annual cumulative limit is 150 yuan, so Xiao A actually reimbursed 150 yuan at his own expense of 400- 150 yuan. I won't be reimbursed if I go to the clinic to get medicine in the future, because the quota is used up.
Hospitalization:
Residents' medical insurance can be reimbursed twice when they are hospitalized in Zhengzhou: basic medical insurance for residents and medical insurance for serious illness for residents.
The hospitalization reimbursement rules are as follows:
1. Basic medical insurance for residents: in the first reimbursement, the highest reimbursement for residents' medical insurance is 150,000/year, the lowest deductible is150 yuan, and the highest reimbursement rate is 90% (township hospitals);
At the same time, after hospitalization reimbursement, if the expenses in the medical insurance catalogue borne by individuals exceed1.65,438+0,000, they can be reimbursed for the second time through residents' serious illness insurance;
2. Residents' medical insurance for serious illness: if the amount borne by individuals exceeds 1. 1 10,000 after hospitalization reimbursement, a second serious illness reimbursement can be made;
For example, we will see more clearly:
Old A, a resident of Zhengzhou, spent 200,000 yuan in a third-class first-class hospital in Zhengzhou due to illness, so his hospitalization expenses are:
Basic medical insurance:
Part 0-2000: deductible, reimbursed to 0 yuan;
2000-8000: 6000 * 55% = 3300 yuan; 200000-8000 =192000 * 65% =124800 yuan;
Then Lao A will reimburse 3300+124800 =128100 yuan. At the same time, you can also enjoy medical insurance for serious illness and make a second reimbursement.
Residents' medical insurance for serious illness: The expenses borne by the above-mentioned senior A after reimbursement are: 200,000-128100 = 71900 yuan, which reaches the deductible line of reimbursement for serious illness medical insurance, so he can enjoy reimbursement for serious illness medical insurance. Then the second reimbursement: 71900-1000 = 60900 * 60% = 36540 yuan, so the old A*** reimbursed128100+36540.
It can be seen that it is very necessary for us to participate in 280 yuan residents' medical insurance every year.
If there is no five insurances and one gold paid by the unit, residents in the community must participate in medical insurance regardless of whether they have purchased commercial insurance. Because if you don't participate in social security, buy commercial insurance, such as hospitalization (whether it is micro-medical care or millions of medical care, etc.). ), reimbursement of about 70%. If there is social security, most medical insurance will be reimbursed at 100% after deducting the deductible for social security reimbursement. Therefore, if we buy commercial medical insurance and there is no employee medical insurance, then residents' medical insurance must participate, which can increase our reimbursement amount.
How should different groups of people participate in insurance?
1. If you are a new insured, you need to go to the medical insurance agency or its designated collection point to complete the registration and verification before paying.
2. Newborns under one year of age shall go to the street (township) office where the household registration is located with the household registration book.
3 medical assistance object by the urban and rural medical assistance fund in full or fixed payment. (The specific embossed logo shall be formulated by the local government)
4. The basic medical insurance for urban and rural residents deposited in the social security card is not equal to payment. You need to follow the steps through the payment channels provided by the tax authorities.
These are the main purposes of the medical insurance for urban and rural residents in 280 yuan that we paid this year.