A, social medical insurance matters needing attention:
1 is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection.
2. Composition of social overall medical insurance: the payment base is m: wage income of employees+allowance. The unit pays 8% m every year; Individual employees pay 2% m every year;
3. The unit pays 8% m: 6.6% m to 7%M into the overall account (1%M to 1.4%M into the personal account)-hospitalization expenses;
4. 2% m of the salary paid by the individual: 2% m goes into the personal account (plus the unit payment 1%M to 1.4% M)- outpatient expenses.
5. Note: The hospitalization expenses are reimbursed from the overall account, and the amount is the same for everyone; Outpatient expenses are deducted from personal accounts (that is, medical insurance cards), and everyone is different.
2. How to check the progress of medical insurance reimbursement? How to check whether the medical insurance reimbursement status is normal?
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Go directly to the inpatient window of the hospital first, and when you register for hospitalization, he will tell you whether it can be reimbursed normally.
Second, the query of social security window or social security self-service teller machine will also know the current medical insurance payment status.
Third, you can also learn about it through the local social security website.
Fourthly, you can also inquire through our telephone number 12333.
However, the third and fourth methods both need to search for passwords on the Internet and need to be reset by the labor department.
Three. Legal basis of medical insurance reimbursement:
The basic medical insurance system in China adopts the mode of combining social pooling with individual accounts. The basic medical insurance fund shall, in principle, implement municipal co-ordination. The basic medical insurance covers all employers and their employees in cities and towns; All enterprises, state administrative organs, institutions and other units and their employees must fulfill the obligation to pay the basic medical insurance premium. At present, the employer's contribution ratio is about 6% of the total salary, and the individual contribution ratio is 2% of my salary. Part of the basic medical insurance premium paid by the unit is used to establish the overall fund, and part of it is included in the personal account; The basic medical insurance premiums paid by individuals are included in personal accounts. Pooling funds and individual accounts bear different responsibilities for payment of medical expenses. The overall fund is mainly used to pay for the hospitalization and outpatient treatment of some chronic diseases, and the overall fund has a minimum payment standard and a maximum payment limit; Personal accounts are mainly used to pay for general outpatient expenses.
What everyone needs to pay attention to is that the drugs reimbursed by medical insurance are specific, and only drugs in the medical insurance catalogue can be reimbursed, and drugs outside the medical insurance catalogue cannot be reimbursed, such as many expensive imported innovative drugs and patented drugs.