When paying employees' basic medical insurance, we need to understand the relevant systems and policies that must be paid according to regulations, so that the basic interests of employees can be protected and the personal interests of employees can be protected. So what is the ratio standard for employees’ basic medical insurance?
1. Employee basic medical insurance ratio standard
1. Outdoor and emergency medical expenses: The cumulative medical expenses that meet the scope of basic medical insurance exceed 2,000 yuan within the year (January 1-December 31).
2. Settlement ratio: 50% of the part of the dispatched personnel exceeding 2,000 yuan during the contract period, and 50% of the individual will be paid by themselves; the maximum amount of reimbursement for the dispatched personnel in one year is 20,000 yuan.
3. Insured persons must properly keep outpatient medical documents (including receipts, prescription bases, etc.) for treatment in designated hospitals as medical expense reimbursement vouchers.
4. Outpatient medical treatment for three special diseases: When insured persons suffer from malignant tumors, radiation therapy and chemotherapy, kidney dialysis, and kidney transplantation, anti-rejection drugs must be taken in the outpatient clinic, the second and third-level designated hospitals in which the insured seeks medical treatment will be issued a "disease diagnosis certificate", and fill out the "Medical Insurance Special Disease Application and Approval Form" and submit it to the district medical insurance center for approval and filing. For outpatient clinics for these three special diseases, medical treatment and medication are only allowed in designated hospitals approved for treatment, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred meet the scope specified in the outpatient special disease, they shall be settled in accordance with the hospitalization.
5. Hospitalization.
2. What is medical insurance
Medical insurance is an insurance to compensate for the medical expenses brought by diseases. When employees are sick, injured or have children, the society or enterprises provide necessary medical services or material assistance to social insurance. Such as public medical care and labor insurance medical care in China. The medical expenses of Chinese employees are jointly borne by the state, unit and individual to reduce the burden on enterprises and avoid waste.
In my country, medical insurance is in its infancy. Currently, it is mainly used as an additional insurance for the main insurance. For example, it is more common as an additional insurance for personal accident insurance. Because whether it is group personal insurance (insurance liability includes disease or accidental injury accident) or group personal personal injury insurance (insurance liability only includes accidental injury accident), the insurer only pays the death insurance or disability insurance, and does not bear the medical expenses incurred. Therefore, in order to obtain more adequate insurance coverage, it is necessary to obtain medical insurance.
3. How to pay for medical insurance
Medical insurance cannot be handled separately and must be bound to pension insurance. If you want to buy commercial medical insurance, you can consult major insurance companies.
Individual social security payment process: Pension insurance: bring your ID card, unemployment certificate and 2 1-inch photos and go to the business window of the local social security center to handle it.
Medical insurance: After completing the pension insurance procedures, take the above materials and the completed pension insurance manual to go to the business window of the local medical insurance center. Just pay the fees normally according to regulations.
Generally, the payment base can be determined according to the different levels specified, and the proportion is generally 20% of the elderly and about 8% of the medical care.
The above is a related introduction to the basic medical insurance ratio standards for employees. Pay attention to the payment of medical insurance. The specific procedures must be prepared in advance, and apply and handle the application and processing in accordance with the relevant procedures.
