First, set the upper and lower limits of the social security base. The upper limit is 300% of the average salary of last year, the lower limit is 40% of the average salary of last year, and the medical care is 60%. Your pension and medical base are different, so your social security base should be between them. If the base exceeds the minimum pension, count yourself as the base; if the base does not reach the minimum medical care, count as the minimum.
Second, employees should participate in the basic old-age insurance, and both employers and employees should pay the basic old-age insurance premium. Generally speaking, endowment insurance: 20% for units and 8% for individuals; Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Medical insurance: 8% for units and 2% for individuals.
Question and answer of medical insurance policy
1. How many forms of medical insurance are there?
Medical insurance is divided into three forms: comprehensive medical insurance (including outpatient and inpatient), inpatient medical insurance and special medical insurance.
Employees and retirees with Shenzhen household registration in the employing unit shall participate in comprehensive medical insurance.
Laborers and unemployed persons of the employing unit shall participate in hospitalization medical insurance during the period of receiving unemployment benefits.
Retired personnel and disabled revolutionary servicemen above Grade B shall participate in special medical insurance.
2. What is the ratio of the employer and the insured to pay the insurance premium?
Employers and insured persons pay medical insurance premiums according to the following standards:
(1) The comprehensive medical insurance premium for on-the-job employees shall be paid at 9% of their total monthly salary, of which 7% shall be paid by the finance or the employing unit and 2% by individual employees; The monthly salary of employees shall not be less than 60% of the average monthly salary of employees in the previous year, and shall not be higher than 300%, and the excess shall be exempted from medical insurance premiums.
(2) The medical insurance premium for retirees shall be paid in full by the finance, the employer or the endowment insurance fund according to 12% of my monthly pension;
(3) The medical insurance premium for hospitalization of workers shall be paid by the employer at 2% of the average monthly salary of employees in the previous year, and the individual shall not bear it;
(four) the hospitalization medical insurance premium for the unemployed during the period of receiving unemployment benefits shall be paid by the unemployment insurance institution at 2% of the average monthly salary of employees in the previous year, and the individual shall not bear it.
3. How to pay the medical insurance premium?
The employer shall pay medical insurance premiums on a monthly basis. Medical insurance premiums paid by individual employees shall be withheld and remitted by the employer.
The medical insurance premium paid by the employer is included in the cost and management expenses.
Medical insurance premiums paid by individuals shall be paid before tax.
4. What is the ratio of personal account funds to * * * economic funds?
The medical insurance premium paid by the employer and the insured individual shall be separately established by the Municipal Social Security Bureau for unified management. Specific measures are as follows:
(a) the finance or the employer has paid the comprehensive medical insurance premium, and after withdrawing the management fee and risk reserve, 60% of the insured persons over 40 years old will be credited to the personal account, and 40 will be credited to the * * * economic fund; The insured under the age of 44, 50% credited to personal account, 50% credited to * * * economic fund. Personal contributions are all credited to personal accounts.
(2) After the management fee and risk reserve are extracted, all hospitalization medical insurance premiums will enter the medical insurance fund.
(three) retired personnel, second-class disabled revolutionary servicemen above B do not set up medical personal accounts.
(four) workers do not establish medical personal accounts.
5. How does medical insurance pay interest?
The funds deposited in the employee's personal account shall be calculated according to the interest of urban and rural residents' demand deposits stipulated by the state from the next month 15.
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6. What kind of insurance benefits can people who participate in comprehensive medical insurance enjoy?
For employees participating in comprehensive medical insurance, 90% of the basic medical expenses for hospitalization shall be paid by the * * * fund, and personal cash payment shall be 10%. Outpatient basic medical expenses shall be paid by personal account.
For retirees who participate in comprehensive medical insurance, 95% of the basic medical expenses for hospitalization shall be paid by the * * * fund and 5% by individuals in cash. Outpatient basic medical expenses shall be paid by personal account.
After the personal account is used up, the excess does not exceed 10% of the average salary of employees in the previous year, and all of them are taken care of by individuals. For the part exceeding 10% of the average salary of employees in this city last year, the reimbursement ratio shall be determined according to the relevant provisions of the basic medical insurance and the level of hospitals: for tertiary (municipal) hospitals, 65% shall be paid by the * * * fund and 35% by individuals; Two (district) hospitals, 70% paid by the * * * economic fund, 30% paid by individuals; A (street, town) hospital, * * * fund to pay 75%, individuals pay 25%.
7. What kind of treatment do people who participate in hospitalization medical insurance have?
For workers and unemployed people who participate in hospitalization medical insurance, 90% of the basic medical expenses for hospitalization shall be paid by the * * * fund and 10% by individuals in cash. Outpatient basic medical expenses are paid by themselves (if there is a balance in the individual account of the unemployed, it can be used to pay for outpatient basic medical expenses).
8. What are the primary, secondary and tertiary health care targets and people participating in the special medical insurance in the city?
Medical insurance benefits?
The medical expenses of the primary, secondary and tertiary medical care objects and special medical insurance objects in this Municipality shall be paid by the Social Security Bureau in accordance with the provisions in the basic medical insurance coverage, and the part beyond the provisions of the basic medical insurance shall be paid by the payment channel.
9. What kind of people need to provide start-up funds to participate in medical insurance?
Finance and the employing unit shall provide start-up funds for the medical personal accounts of employees and retirees over 45 years of age, and make a one-time entry into the personal accounts when they are insured for the first time. The standard of start-up capital is: 5% of the total wages of employees over 45 years old in the previous year, and 10% of the pension for retirees in the previous year.
10. What kind of medical insurance benefits do people who have been insured for less than one year in a row have?
The insured person has been insured for less than six months in a row, and the medical expenses incurred during this period are less than 10 thousand yuan, and the Municipal Social Security Bureau shall pay a certain proportion from the medical insurance fund according to the regulations; If you have lived for six months but less than one year, and the medical expenses incurred during this period are less than 20,000 yuan, the Municipal Social Security Bureau will pay a certain percentage from the medical insurance fund according to the regulations.
1 1. What treatment does the insured enjoy for special inspection?
80% of the special examination and treatment expenses approved by the Social Security Bureau shall be paid by the * * * Economic Fund and 20% by individuals in cash.
12. Under what circumstances can the insured not enjoy medical insurance benefits?
Under any of the following circumstances, you shall not enjoy the medical insurance benefits stipulated in these regulations:
(a) without the permission of the Social Security Bureau, to see a doctor in a non-agreed medical unit;
(two) due to intentional self-injury or my illegal behavior caused by injury;
(three) the implementation of beauty, or corrective treatment of congenital disability;
(four) in accordance with the relevant provisions should be at their own expense.
13. How to reimburse the out-of-town referral medical insurance fee?
The expenses incurred in emergency treatment, visiting relatives, traveling and approved referral outside the city shall be submitted to the Social Security Bureau for review and reimbursement with medical records or copies of medical records of public hospitals and receipts. When reimbursing outpatient expenses, the corresponding amount should be deducted from the personal account.
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14. What will happen to personal accounts when medical insurance is terminated under special circumstances?
When the insured person leaves the city, the balance of his personal account will be transferred to the social insurance institution where his account is located, and he can continue to enjoy it. If there is no corresponding local institution, it will be returned to him at one time.
The balance of the individual account of the resettlement person shall be returned to him in one lump sum.
When the insured dies, the balance of the personal account shall be inherited by the heir in accordance with the provisions of the inheritance law. If there is no heir, it will be transferred to medical insurance fund.
Basic concept of endowment insurance
Endowment insurance is an important part of social security system and one of the five most important social insurances. The so-called endowment insurance (or endowment insurance system) is a social insurance system established by the state and society according to certain laws and regulations to solve the basic life of workers who reach the working age limit stipulated by the state and terminate their labor obligations or quit their jobs because of old age. This concept mainly includes the following three meanings:
(1) The old-age insurance will take effect automatically after the elderly within the legal scope completely or basically withdraw from social labor life. The "complete" mentioned here is characterized by the separation of workers from the means of production; The so-called "basic" means that participation in production activities has not become the main content of social life. It should be emphasized that the legal age limit (different countries have different standards) is a practical measure.
(2) The purpose of endowment insurance is to ensure the basic needs of the elderly and provide them with a stable and reliable source of life.
(3) Endowment insurance is based on social insurance to achieve the purpose of protection. Old-age insurance is a social security system widely implemented in all countries of the world. Generally speaking, it has the following characteristics: ① It is enforced by national legislation, and all enterprises and individuals must participate. Those who meet the conditions for receiving a pension can receive a pension from the social insurance department; (2) The source of endowment insurance expenses is generally shared by the state, units and individuals, or by units and individuals to achieve extensive social mutual assistance; (3) Endowment insurance is social, has great influence, enjoys a large number of people for a long time, and costs a lot. Therefore, it is necessary to set up specialized agencies to implement unified planning and management of modernization, specialization and socialization.
Types of endowment insurance
The emergence and development of endowment insurance is closely related to the country's politics, economy and social culture. It is the product of socialized mass production and the symbol of social progress. At present, there are three countries that implement the old-age insurance system in the world, namely, insurance-funded (also known as traditional) old-age insurance, compulsory savings old-age insurance (also known as provident fund model) and national overall old-age insurance. In addition, according to the specific national conditions of China, China creatively implemented the basic old-age insurance reform model of "combining social pooling with individual accounts". After five years of exploration and improvement, this model has gradually matured. With the passage of time, this model is bound to become a basic type with more and more influence in the history of the development of endowment insurance in the world.
Development and present situation of endowment insurance
Retirement means that cadres who participated in revolutionary work before the founding of the People's Republic of China can leave their posts to rest when they reach the prescribed age. Including/kloc-0, who joined the revolutionary army led by the * * * production party before September 30, 949; Participate in revolutionary work and enjoy the treatment of the supply system in the liberated areas; People engaged in revolutionary work in enemy-occupied areas (members of underground party member or some peripheral organizations of the Party); And1September 2, 9491cadres who joined the democratic parties a few days ago. For retired cadres, the relevant departments of the central government have stipulated the principle of "slightly preferential treatment in life". Mainly (1) except the original salary, all kinds of unproductive welfare benefits remain unchanged, and according to different periods of participating in revolutionary work, I will increase my standard salary 1 to 2 months every year as a living allowance. (2) The supply of housing, medical care, automobiles and daily necessities shall be given proper care. (3) A certain amount of nursing subsidies can be given to those who are paralyzed by illness and cannot take care of themselves. (4) In addition to continuing to enjoy the treatment of visiting relatives stipulated by the state, the travel expenses for visiting parents, children or returning home will also be reimbursed. ⑤ Cadres above14 and 18 can enjoy the treatment at department level and county level respectively.
Retired employees refer to employees who retire from production posts at a specific age. Retired workers who receive 100% of their original salary according to relevant regulations also belong to the scope of retired workers.
The current retirement regulations are: male cadres and workers are 60 years old, female cadres are 55 years old and female workers are 50 years old; Male and female workers engaged in underground, high altitude, high temperature, particularly heavy physical labor or other jobs harmful to health can retire five years in advance. All the above must have 10 years of continuous work experience.
For retired workers who meet the above conditions, 90% of the standard salary will be paid to those who participated in the work during the War of Resistance against Japanese Aggression period; Those who participated in the work during the War of Liberation were given 80%, and those who participated in the work after the founding of the People's Republic of China were given 60? 75%。 Now all localities have adjusted the above regulations, and the subsidy standards are not uniform enough. Generally, the subsidy for those who worked before the founding of the People's Republic of China for 30 years is 95% of the original salary. 100%; 1952, the compensation will be 90? 95%, some from 1957 before the end of the work to give subsidies.
China's old-age insurance premium (national enterprise) was originally planned by the whole country, but it was changed to be borne by the enterprise, that is, the unit where the employees worked, during the Cultural Revolution. With more and more retired workers, the burden of enterprises, especially old enterprises, is increasing day by day, and some of them are as high as 70% of the total wages of enterprise employees. 80%, while some new enterprises only account for 2? 3%, so there is a problem that the burden on enterprises is extremely light and heavy. In order to solve this problem, 1985, the State Council approved the Ministry of Labor and Personnel to start a pilot project to implement pension pooling. It will be gradually promoted in the future. By 199 1, more than 2,300 cities and counties across the country have implemented pension pooling. On the one hand, it solves the problem of uneven burden on new and old enterprises, on the other hand, it guarantees pensions. By the end of 1988, there were 21150,000 retired employees nationwide, and the pension benefits were 32.07 billion yuan, with an average of 157 1 yuan per person per year.
1991On June 26th, the State Council promulgated the Decision on the Reform of Enterprise Endowment Insurance System, which marked that the reform of enterprise endowment insurance system entered the stage of organized reform design from spontaneous pilot. The "Decision" calls for changing the way that the old-age insurance is completely borne by the state and enterprises, and the state, enterprises and individuals should share the burden, and individual employees should also pay a certain fee.
On March 1995 and 1 day, the State Council issued the Notice on Deepening the Reform of the Old-age Insurance System for Enterprise Employees (Guo [1995] No.6), and at the same time issued one or two measures for the implementation of the combination of social pooling and individual accounts for the basic old-age insurance for enterprise employees, and designed various models in different categories. 1995 12.29 "opinions of the Ministry of labor on establishing enterprise supplementary endowment insurance system" was officially issued, which made enterprise supplementary endowment insurance enter the standard operation stage.
According to the practice of the past year, the Social Security Research Office of the Institute of Social Development of the State Planning Commission has completed the research on unifying the national endowment insurance model. The report of this project received a new instruction from Comrade Zhu Rongji on1March 3, 1996: "Please ask the relevant departments (including the Commission for Restructuring the Economy, the Ministry of Labor and the China Financial Leading Group Office) to discuss this article. I think we should summarize the reform experience since the release of the the State Council Notice as soon as possible, and the best merger can be improved. " The research results directly promoted the timely promulgation of the Decision of the State Council on Establishing a Unified Basic Old-age Insurance System for Enterprise Employees (Guo Fa [1997] No.26).
By the end of 1996, 28 provinces, municipalities directly under the central government, autonomous regions and five system planning departments had issued the reform plan of "combining social planning with individual accounts", and more than 200,000 retired workers received pensions according to the new method.
With the consent of the provincial government, some cities with separate plans have adopted different plans from provinces and regions, such as Ningbo, Zhejiang, Qingdao, Shandong and Wuhan, Hubei. At present, the focus of work in areas where reform programs have been introduced has begun to shift to cities, and many cities are organizing calculation, analysis and formulation of implementation rules, and making preparations for publicity, training and database establishment. In areas with rapid progress, such as Hubei Province and Anhui Province, the government has approved the implementation plans of some cities, and some cities will be put into substantive operation one after another.
The cost of endowment insurance for employees of collective enterprises has reached more than 2,000 cities and counties, and non-public enterprises have gradually been included in the scope of social endowment insurance. In addition, the 1 1 department has implemented industry co-ordination. The contribution level of general enterprises is about 2 1% of the total wages, and that of individuals is about 3% of the total wages.
Up to now, 88 million employees and 23 million retirees have participated in the old-age insurance. In recent years, the coverage of old-age insurance has been expanding. According to the statistics of relevant departments, employees participating in endowment insurance have accounted for 76% of all enterprise employees, including 96% of state-owned enterprises, 45% of urban collective enterprises and 24% of other types of enterprises. 1996, the national basic old-age insurance fund income12 billion yuan, expenditure10.8 billion yuan. The accumulated balance is 50.9 billion yuan.
1June, 1998, the Notice of the State Council on Relevant Issues Concerning the Implementation of Provincial Overall Planning and the Transfer of Industry Overall Planning to Local Management of the Basic Old-age Insurance for Enterprise Employees was officially promulgated. Ministry of Railways, Ministry of Communications, Ministry of Information Industry (formerly Ministry of Posts and Telecommunications), Ministry of Water Resources, Civil Aviation Administration, Coal Bureau (formerly Ministry of Coal), Nonferrous Metals Bureau (formerly China Nonferrous Metals Industry Corporation), State Power Company (formerly Ministry of Electric Power), China Petroleum and Natural Gas Corporation, China Petrochemical Group Corporation (formerly Oil and Natural Gas Corporation), banking system (ICBC, Agricultural Bank, China Bank, China Construction Bank, Bank of Communications, etc. The "Notice" requires speeding up the implementation of the provincial-level overall planning of the basic old-age insurance for enterprise employees. 1before the end of 998, all provinces, autonomous regions and municipalities directly under the central government (hereinafter referred to as provinces, autonomous regions and municipalities) should implement provincial-level overall planning of basic old-age insurance for enterprise employees (hereinafter referred to as provincial-level overall planning), establish a provincial-level adjustment mechanism of basic old-age insurance funds, and take the proportion of adjustment funds as the principle to ensure the timely and full payment of basic pensions for enterprise retirees within provinces, autonomous regions and municipalities. By the year 2000, within the scope of provinces, autonomous regions and municipalities, it is necessary to basically realize the proportion of basic old-age insurance premiums paid by enterprises, uniformly manage and dispatch the use of basic old-age insurance funds, and implement centralized management of social insurance agencies at the provincial level. The scope of provincial overall planning includes state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises and other urban enterprises and their employees in all provinces, autonomous regions and municipalities directly under the Central Government (including cities with separate plans, sub-provincial capital cities, special economic zones and development zones). Urban individual economic organizations and their employees should also participate in the basic old-age insurance and be included in the provincial overall planning.
1 September, 9981day, the payment area of the balance of the basic old-age insurance fund should change the fund settlement method, levy the revised old-age insurance premium on all enterprises and individual employees, and pay the basic pension in full to enterprise retirees. All provinces, autonomous regions and municipalities should actively create conditions to speed up the socialized distribution of basic pensions for enterprise retirees and promote the process of socialized management.
Part of China's endowment insurance.
China is a developing country with underdeveloped economy. In order to make the old-age insurance not only play the role of ensuring life and stabilizing society, but also adapt to the needs of different economic conditions, which is conducive to the improvement of labor productivity. Therefore, the endowment insurance in China consists of three parts (or three levels). The first part is basic old-age insurance, the second part is supplementary old-age insurance for enterprises, and the third part is personal savings old-age insurance.
What is the basic old-age insurance system?
The basic old-age insurance, also known as the national basic old-age insurance, is a compulsory old-age insurance system to protect the basic needs of retirees according to the unified national policies and regulations. In China, before 1990s, employees in enterprises implemented a single pension insurance system. 199 1 "the State Council's decision on the reform of the old-age insurance system for enterprise employees" clearly states: "With the development of economy, a system combining basic old-age insurance with enterprise supplementary old-age insurance and employee personal savings old-age insurance will be gradually established. Since then, China has gradually established a multi-level old-age insurance system. In this multi-level old-age insurance system, the basic old-age insurance is the first and highest level.
What is a basic pension
Before the reform of China's old-age insurance system, basic pension, also known as pension and retirement fee, was the most important old-age insurance treatment. That is, the provisions of relevant national documents. After a worker is old or incapacitated, according to his contribution to the society and his eligibility for old-age insurance or retirement conditions, the monthly or lump-sum insurance benefits are mainly used to protect the basic needs of employees after retirement. 199 1 the State Council's decision on the reform of the old-age insurance system for enterprise employees (Guo Fa [1991] No.33) stipulates that with the development of economy, a system combining basic old-age insurance with enterprise supplementary old-age insurance and employee personal savings old-age insurance will be gradually established. 1997 "Decision of the State Council on Establishing a Unified Basic Old-age Insurance System for Enterprise Employees" (Guo Fa [1997] No.26) further clarifies that people's governments at all levels should incorporate social insurance into their local national economic and social development plans and implement the principle that basic old-age insurance can only guarantee the basic livelihood of retirees. In order to continuously improve the life of retirees with the development of economy and society, and reflect the principle of distribution according to work, the difference of regional development level and economic benefits of enterprises, all regions and relevant departments should vigorously develop enterprise supplementary endowment insurance under the guidance of national policies, and at the same time give play to the supplementary role of commercial insurance. At present, according to the general thinking of the country on the basic old-age insurance system, the target replacement rate of the basic old-age insurance in the future is determined to be 58.5%. It can be seen that the main purpose of the future basic pension is to ensure the basic life of retirees in their later years.
What is enterprise supplementary endowment insurance?
Supplementary endowment insurance for enterprises refers to an auxiliary endowment insurance established by enterprises according to their own economic strength and under the implementation policies and conditions stipulated by the state. It is located at the second level of the multi-level endowment insurance system, which is jointly implemented by the national macro guidance and internal decision-making of enterprises. There are differences and connections between enterprise supplementary endowment insurance and basic endowment insurance. The difference is mainly reflected in the different levels and functions of the two kinds of endowment insurance, and its connection is mainly reflected in the fact that the policies and levels of the two kinds of endowment insurance are interrelated and inseparable. Enterprise supplementary endowment insurance is managed by the labor and social security department, and the unit that implements supplementary endowment insurance should choose the agency recognized by the labor and social security administrative department. There are three ways to raise funds for enterprise supplementary endowment insurance: pay-as-you-go system, partial accumulation system and complete accumulation system. The enterprise supplementary endowment insurance premium can be fully borne by the enterprise or jointly borne by both the enterprise and the employee, and the payment ratio is determined by the agreement between the employer and the employee. Generally, there is a board of directors composed of employers and employees in the enterprise, which is responsible for the supplementary endowment insurance of the enterprise.
What is personal savings endowment insurance?
Personal savings endowment insurance for employees is an integral part of China's multi-level endowment insurance system, and it is a supplementary insurance form for employees to participate voluntarily and choose their own agencies. Personal savings endowment insurance for employees handled by social insurance institutions shall be formulated separately by the competent department of social insurance. Individual workers pay personal savings endowment insurance premiums according to their salary income, which are credited to the personal accounts of endowment insurance opened by local social insurance institutions in the relevant banks, and interest is calculated according to the savings deposit rate of urban and rural residents not lower than or higher than the same period, so as to encourage individual workers to participate in savings endowment insurance. The interest earned is credited to the personal account, and the principal and interest are owned by the individual employees. Workers who reach the statutory retirement age and are approved to retire will pay the savings pension insurance in one lump sum or in installments with their personal accounts. When employees move across regions, the savings endowment insurance in personal accounts should be transferred accordingly. If an employee dies before reaching retirement age, the savings endowment insurance fund credited to his personal account shall be inherited by his designee or legal heir. The implementation of personal savings endowment insurance for employees aims at expanding the sources of endowment insurance funds, raising endowment insurance funds through multiple channels and reducing the burden on the state and enterprises; It is conducive to eliminating the long-standing concept that insurance costs are entirely borne by the state, and enhancing employees' awareness of self-protection and their initiative to participate in social insurance; At the same time, it can also promote extensive mass supervision of social insurance work.
Personal savings endowment insurance can be linked with enterprise supplementary endowment insurance to promote and improve the enthusiasm of employees.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.