At present, there are two main types of medical insurance supported by the state: employee medical insurance and resident medical insurance.
The full name of employee medical insurance is enterprise employee medical insurance, and there are two types of participants. One is a fixed work unit, the enterprise pays about 70% of the cost, and the individual pays about 30% of the cost, which is commonly known as one of the five insurances and one housing fund, medical insurance. The second category is for individual flexible workers, and all the costs of such are borne by the individual.
The full name of residents' medical insurance is medical insurance for urban and rural residents, and in some places it is called NCMS, which is actually the same kind of insurance. A small part of this kind of insurance is paid by individuals, and most of the financial subsidies of the state and provinces and cities are included in the large pool of medical insurance pools for medical security.
Employee medical insurance is paid on a monthly basis, and enterprises and individuals generally need to pay a total of 8%-12% of the base medical expenses, and the minimum monthly payment is also four or five hundred yuan. The highest level is three times the average salary as the base of payment. Different provinces and cities, the general personal account will return 2% of the personal payment fee every month or a fixed amount will be returned to the personal medical account. When the retirement age stipulated by the state is reached, the cumulative payment period of employee medical insurance can be used for employee medical insurance retirement, and the employee medical insurance treatment can be enjoyed for life, and the personal account will still return money after retirement!
According to the requirements of the employee medical insurance retirement policy in various provinces and cities, the general trend is that men can only retire after 30 years and women can retire after 25 years. At present, in some areas, men who have completed 25 years and women who have completed 20 years can apply for medical insurance retirement; In a very few areas, you can apply for medical insurance retirement after 15 years!
Employee medical insurance outpatient clinics generally require designated first-class hospitals or community health centers, and there is generally a starting line. Most of the expenses can be reimbursed according to the policy for the part of the annual medical expenses that exceed the minimum payment line, and about 70% of the expenses within the policy can be reimbursed for outpatient services in first-class hospitals. According to the different levels of hospitalization, 95% to 80% of the medical expenses within the policy can be reimbursed, and there is a starting line for hospitalization, which generally ranges from a few hundred yuan to 1,500 yuan. Whether you are visiting an outpatient clinic or an inpatient patient, you can use the balance of your personal medical account, and when the balance account is insufficient, you will need to pay additional out-of-pocket medical expenses. The balance of the employee's personal medical insurance account can generally meet the out-of-pocket fund needs of outpatient and inpatient hospitals. The annual cumulative reimbursement amount of employee medical insurance outpatient clinics generally ranges from 5,000 yuan to 10,000 yuan according to different provinces and cities.
The medical insurance for urban and rural residents is paid on an annual basis, and the medical insurance for the next year is paid at the end of the current year. In 2024, the lowest level of medical insurance for urban and rural residents has risen to about 400 yuan, and some economically developed areas need to pay 100 yuan. The medical insurance for urban and rural residents will not be accumulated at the end of the year. If you want to be reimbursed, you need to pay it every year. There is no personal account for medical insurance for urban and rural residents, and there is no money refund.
The reimbursement rate within the policy of a first-class hospital is generally about 50%, and the annual reimbursement amount generally ranges from a few hundred yuan to about 2,000 yuan. There is a minimum payment for hospitalization, and the starting payment line is similar to that of employee medical insurance, and the reimbursement ratio within the policy is low, and there are many employee medical insurance.
On the whole, the medical treatment enjoyed by employee medical insurance is significantly higher than that of resident medical insurance. However, the low-grade annual payment of employee medical insurance should also be more than 5,000 yuan, which is more than ten times the annual payment of resident medical insurance, and the gap is not ordinarily large! In the case of personal financial ability, employee medical insurance should be the first choice! If the financial ability is not good, I have to retreat and ask to pay for the resident medical insurance!