What are the differences between residents' medical insurance and employee medical insurance?Look at these 4 points

With the start of the 2022 city and rural residents' medical insurance concentrated payment, some people may ask what is the difference between this medical insurance and the medical insurance paid by the unit?

Today, some characteristics of urban and rural residents' medical insurance and employee medical insurance are combed to compare them one by one

Different insureds

The participating crowds of urban and rural residents' medical insurance are rural residents, urban non -employed residents, students in schools, and obtained residence permits in the preparatory area (children under the age of 12 years of age, their guardians have the same residence permit with residence permits) The permanent population, the unscrupulous Hong Kong, Macao and Taiwan residents who live in the Mainland (mainland) and apply for a residence permit for Hong Kong, Macao and Taiwan residents, and Hong Kong, Macao and Taiwan college students studying in the Mainland (mainland).

The employee's medical insurance participants are on -the -job employees, flexible employment, and individual industrial and commercial households.

Different payment conditions

The medical insurance for urban and rural residents pays a year based on a year -on -year insurance. According to the National Medical Insurance Bureau's "Notice on the Basic Medical Guarantee Work of Urban and Rural Residents in 2022" (Medical Insurance Fa [2022] No. 20), in 2022, continue to improve the standard of financial subsidies for medical insurance participation in residents The yuan, no less than 610 yuan per person per year; the corresponding simultaneous improvement of personal payment standards is 30 yuan, reaching 350 yuan per person per year.

The employee medical insurance pays monthly, and the employee payment of the unit shall be paid by the unit monthly withdrawal, and the expenses shall be paid by the unit and individuals. The medical insurance expenses of flexible employment shall be borne by the individual. If partially meets the conditions, the medical insurance payment subsidy may be applied for.

Different degrees of protection

In contrast, the reimbursement of medical insurance for urban and rural residents is relatively low. According to the public data of the National Medical Insurance Bureau, the proportion of reimbursement for hospitalization expenses within the scope of medical insurance and residents' medical insurance policies in my country has reached about 80%and 70%, respectively.

Taking Xi'an City, Shaanxi Province as an example: In 2022, the third -level hospitals of Xi'an on -the -job employees from the third -level hospital will be paid above 10,000 yuan, and the reimbursement ratio is 88%. The maximum payment limit of 400,000 reimbursement is 95%. During one year, the medical insurance costs that meet the medical insurance regulations in accordance with the medical insurance regulations and exceed the medical insurance regulations due to the treatment of diseases and more than 400,000 yuan (400,000 yuan) are more than 95%of the employee's large medical subsidy insurance payment. Essence The reimbursement ratio of residents' medical insurance in the third -level hospital is 60 %, and the maximum payment limit for the overall funding fund of a medical insurance year is 200,000 yuan; For medical expenses, more than 10,000 yuan can enjoy compensation for major illness insurance, including more than 10,000 yuan (excluding) to 100,000 yuan (inclusive). The compensation ratio is 80 %, and there is no top -top line.

Different medical insurance accounts

Urban and rural residents 'medical insurance has canceled the personal account of medical insurance, and all the money paid by the insureds is included in the overall account. The residents' medical insurance card is used to reimburse the expenses of outpatient expenses through outpatient clinics. The employee medical insurance includes a coordinated account and personal account. The basic medical insurance premium paid by the employer is used to establish a overall fund. The basic medical insurance premiums paid by the employees are all included in the personal account. In other words, personal accounts will return a certain amount of money every month according to the situation, which can be used for paying when seeing a doctor.

Reminder: No matter which basic medical insurance is selected, you cannot repeat the insurance, that is, the insured person has two or more participation in insurance information in the same period of time. Repeated insured persons cannot enjoy medical insurance benefits repeatedly, and enjoy the corresponding medical insurance treatment in accordance with the principles of employee medical insurance, college student identity medical insurance treatment, and medical insurance treatment of permanent residence.

Source: Yang Xue, the responsible editor of Xi'an Medical Security Bureau

- END -