The news that retirees pay medical insurance just came out, and the increase in personal contribution rate came again.
In recent years, under the superposition of three factors: the sharp increase of medical expenses, the slow growth of medical insurance financing and the aging population, the medical insurance fund is facing unprecedented pressure on revenue and expenditure. The accumulated balance in many areas can't meet the requirement of "six to nine months" put forward by Ministry of Human Resources and Social Security.
The data shows that the increase of per capita financial subsidies for urban residents' basic medical insurance has been higher than the increase of per capita individual contributions in the past six years, which has increased the proportion of financial subsidies to the total per capita financing from 60.8% in 2009 to 79.3% in 20 14, and the ratio of financial subsidies to individual contributions is close to 4∶ 1. In 20 15 years, the government subsidy standard for urban residents' medical insurance is 380 yuan per person, and the individual contribution is not less than per person 120 yuan.
Jin Weigang, director of Ministry of Human Resources and Social Security Social Security Research Institute, believes that the current proportion of residents' medical insurance financing is unreasonable, and the growth of financing level mainly depends on finance. The proportion of financial subsidies in the whole financing ratio is too large, and the proportion of individual contributions is very small, which will lead to increasing pressure on medical insurance funds in the future.
In order to make up for the medical insurance gap, Finance Minister Lou Jiwei once wrote in Qiushi magazine that it is necessary to deepen the reform of the social security system, speed up the reform of the endowment insurance system, focus on improving personal accounts and adhere to actuarial balance, and establish an incentive and restraint mechanism for overpayment and a more transparent and understandable income and expenditure system. On this premise, we will realize the national overall planning of employees' basic pensions, allocate state-owned capital to enrich the social security fund, accelerate the development of supplementary old-age insurance, and establish a reasonable growth mechanism of basic pensions closely linked to the contribution of contributions. Reform the medical insurance system, establish a reasonable and sustainable medical insurance financing mechanism, study and implement the payment policy for employees' medical insurance retirees, establish an adjustment mechanism for medical insurance benefits commensurate with the level of financing, fully implement the serious illness insurance system for urban and rural residents, reform the payment method of medical insurance, integrate the basic medical insurance system, promote the de-administrative reform of public hospitals, and run township hospitals well in combination with new urbanization to truly establish an orderly pattern of graded diagnosis and treatment.
Among them, the research and implementation of the payment policy for employees' medical insurance retirees has aroused great concern. According to estimates, if retirees pay medical insurance, the average pension is the base. In this way, according to the standard of 20 15, the average contribution of retirees may be about 100 yuan per person per month.
In addition, many local governments explore and encourage residents to buy commercial insurance. In June 5438+February last year, the Ministry of Finance, the State Administration of Taxation and the China Insurance Regulatory Commission issued a notice to implement the personal income tax policy of commercial health insurance in 3 1 cities such as Beijing and Shijiazhuang, Hebei. The expenses of individuals purchasing eligible health insurance products in the pilot areas shall be deducted before individual income tax according to the limit standard of 2,400 yuan/year.
How much is the medical insurance payment for 20 17?
First, the main purpose of the medical insurance card
1, the main purpose of medical insurance is to pay for outpatient treatment.
2. Medical insurance has other uses. You can use this money to buy medicines (over-the-counter medicines), medical instruments, thermometers and sphygmomanometers at designated pharmacies.
Second, how to use the money in the medical insurance card account?
As we all know, employee medical insurance is generally divided into personal accounts and overall accounts. How to use these two accounts respectively?
Personal accounts can pay the following fees:
1, drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;
2. It is used for me to purchase commercial insurance and accident insurance;
3, the basic medical insurance fund Qifubiaozhun below the medical expenses;
4, more than the basic medical insurance fund Qifubiaozhun part, pay personal expenses in proportion;
5. I'll pay for the part of my personal account that is insufficient to pay.
The overall account mainly pays the following fees:
1, hospitalization expenses;
2, malignant tumor radiotherapy, renal dialysis, kidney transplantation after taking anti-rejection drugs outpatient medical expenses;
3, emergency rescue income hospitalized patients, the medical expenses within seven days before hospitalization.
Third, the scope of medical insurance reimbursement
1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents.
The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%.
Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.
2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value).
3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.
4, serious illness insurance reimbursement
After the insured suffers from a serious illness, the personal conceit part that meets the requirements of the municipal medical insurance in the designated medical institutions of the municipal medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% shall be reimbursed by the serious illness insurance fund.
That is, reimbursement amount = self-funded part ×50%
Four, the proportion of medical insurance card reimbursement
In July this year, Ministry of Human Resources and Social Security announced the outline of the 13th Five-Year Plan for the development of human resources and social security. China should stabilize the proportion of hospitalization expenses in the basic medical insurance policy for employees and urban and rural residents at around 75%.
Five, the new use of medical insurance card
1 can be used as an ID card.
20 15 10 1, the criminal law amendment (IX) included the social security card in the scope of documents that can be used to prove identity according to law. Whoever forges, alters or buys or sells social security cards shall be investigated for criminal responsibility according to law; Anyone who uses a forged, altered or embezzled social security card of others shall be investigated for criminal responsibility according to law.
2. Some provinces and cities can keep fit.
In the second half of this year, in some provinces and cities such as Shandong, Chongqing and Jiangsu, employees themselves can use their personal account balance to carry out fitness activities in fitness venues. But it shall not be used to buy food, clothing, fitness equipment or cash.
Six, the use of medical insurance card should pay attention to matters.
1. Cash withdrawal is prohibited.
No unit or individual may violate the scope and requirements of the medical insurance card, and it is strictly forbidden to take cash.
2. Some provincial and municipal medical insurance cards can be used by the whole family.
Starting from the second half of this year, in some provinces and cities such as Zhejiang Province and Guangzhou City, the surplus funds of individual medical insurance accounts over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, so as to realize mutual assistance among family members.
3. The following medical insurance will not be paid.
See a doctor in a non-designated medical institution or buy medicine in a non-designated retail pharmacy (except for emergency);
Self-injury caused by fighting, drug abuse or other illegal acts;
Treatment for alcoholism, suicide, self-mutilation, etc.;
Injuries caused by traffic accidents, medical accidents or other accidents;
And the situation that should be paid by individuals according to national or local regulations.
7. How to check the balance of medical insurance card?
Insured persons can call 12333 for social security consultation or check the balance of medical insurance personal account through BOC savings office, designated hospitals in urban areas and pharmacies.
Finally, if you are not clear about medical insurance, you can call the human resources and social security hotline 12333 for consultation.
With the medical insurance card in hand, life has another guarantee. So be sure to keep it well and use it reasonably, which can not only save money for yourself, but also save trouble.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.