On August 26, the National Health Insurance Administration officially released the Draft for Comments to the public, and there will be changes to employee medical insurance.Do you know the current health insurance policy? How much does the medical insurance cost of the five insurances and one housing fund you pay every month? Where did all this money go? How to use this money when you go to the hospital when you are sick, and how much can the state reimburse you? If you can answer my questions, you don't have to look at them.If you don't know the answer, then you look carefully~
People eat grains, it is inevitable that there will be some headaches and brain fever.Medical insurance policies are closely related to us, and when our families go to the hospital, what kind of medical reimbursement policy we enjoy is our biggest concern.In fact, the medical insurance status of each member of our family is different, so the proportion of medical reimbursement is also different.
For example, we both husband and wife, are office workers, whether company employees, or freelancers, are normal payment of health insurance costs, are employees of health insurance. But our parents, if is the worker retires, also is belongs to the worker health insurance, according to Retiree's reimbursement standard. If the parents are not retired, there should be urban and rural health insurance. Our children, as long as they are not working, are covered by urban and rural health insurance, divided into children's health insurance and college health insurance. So our medical insurance is basically divided into employee medical insurance and urban and rural medical insurance, but the reimbursement ratio varies from place to place. We are talking about the health insurance policies of the Hangzhou area (except Lin 'an, Tonglu County, Chun'an County and Jiande) .
那我们一个月医保费用到底交多少呀？这钱都交到哪里去了呢？
First of all, staff health insurance, you can also open the payroll, to see how much each month in the medical insurance of the five insurances. Pay the standard is based on the average monthly wages of 60% -300% of the base, individuals pay 2% into the personal account, unit pay 10% , into the overall account. Assuming the average monthly salary in Hangzhou is 5,000 yuan, some stingy companies will be in accordance with the minimum standards, that is, 5,000 yuan * 60% = 3,000 yuan as the base, individuals pay 3,000 * 2% = 60 yuan, units pay 3,000 yuan * 10% = 300 yuan. Some welfare companies in accordance with the highest standards, is 5000 * 300% = 15,000 yuan as the base, individuals pay 15,000 * 2% = 300 yuan, units pay 15,000 * 10% = 1500 yuan. So the individual contributions are in the range of 60 to 300 yuan per month, while the company's monthly contributions of 300 to 1,500 yuan will go into the co-ordination account, which has nothing to do with you, because no matter how much you pay, the policy for reimbursement is the same.
In addition, urban and rural health insurance payment, according to different groups of people pay different standards, children's health insurance 250 yuan per year, 60 yuan per year for college students. Adults have two slots to choose from, and there is a difference in reimbursement rates. 600 yuan per year for the first stall in urban and rural areas, 800 yuan per year for the second stall in urban and rural areas. These charges go directly into the pooling account.
Some observant people will find the difference between personal accounts and current year accounts and past year accounts.The medical insurance premiums paid by individuals in the current year will be entered into the current year's account, and the amount that has not been used up in this year will be transferred to the calendar year's account, and there is a difference between the two when used.Seeing a doctor in a hospital outpatient clinic and going to a designated pharmacy to buy medicine can be settled with the balance of the current year's account, and the serious illness insurance premiums and medical hardship assistance funds paid by individuals can be deducted from the amount of the current year's account.As for the purpose of the account over the years, I summarize the key points of 3 points: 1. It is used to pay for the out-of-pocket, self-payment, and self-care expenses incurred in the hospital.In short, it is the cost that is not reimbursed by the national medical insurance; 2. It can be transferred to the relatives of the urban insurance according to regulations, and can be transferred to the spouse, children and parents; 3. If the balance of the account exceeds 4000 in the past year, you can purchase 64 kinds of commercial insurance in the provincial recommended list.
Under what circumstances can I use the money in my co-op account?
Some careful people found out that we went to the hospital because of a cold, when the settlement is charged out of this year's account money, whether it is this year's account or calendar year's account, are their own money AH. So when do we get to use the money in the co-op account?
We go to the hospital to see a doctor is generally divided into outpatient and inpatient two situations, let's talk about outpatient first.Because of the high probability of outpatient visits, most people are still relatively less hospitalized.First use up the balance of the current year's account, and then pay another 1,000 yuan yourself to start the pooled account.Different levels of medical institutions have different reimbursement rates.Only 76 per cent can be reimbursed in tertiary hospitals, 80 per cent in other hospitals and 84 per cent in community hospitals.If you go to a designated hospital to buy medicine, you can be reimbursed 80%, it is worth mentioning that if you call an ambulance 112, the drugs used in the ambulance can be reimbursed 80%, but the ambulance dispatch requires money, which is at your own expense.
In short, tertiary hospitals have the lowest reimbursement ratio, and community hospitals have the highest reimbursement ratio.In order to rationally use medical resources, minor illnesses go to community hospitals, and major illnesses go to major hospitals.Or after seeing a doctor in a tertiary hospital, it will be cheaper to prescribe drugs or injections to a community hospital.And there is no queue for the distance.
再来看住院的报销条件和报销比例。不管什么医保身份，起付条件都是一致的。在一个自然年度内，三级医院起付线是800元，其他医院500元，社区医院300元。如果得比较严重的病，我们一般会在三级医院中治疗，如果是在职职工，当花费不到4万时，医保可以报销82%。当花费在4万-36万之间时，医保可以报销88%。花费大于36万时，需要启动大病保险，可以报销90%。城乡医保当花费大于25万时也可以启动大病保险，可以报销70%，大学生可以报销80%。具体自付比例看下图。
Doesn't that sound great, like 90% of the cost is covered by the state, and it feels really safe, doesn't it? I Can't help liking the government. But, the point is, these are prerequisites, and they are limited to the scope of the health care directory. You know what? There are 169,470 types of legal drugs in China, but only 2,709 are listed in the National Health Insurance Drug Catalogue, accounting for only 1.59 percent of the total. The other 98.4% of the drugs were entirely self-financed. My heart instantly pulled cold.
Let's look at the actual case to see how much medical insurance reimbursement helps us solve?
See below for an invoice of a patient hospitalized in a Zhejiang Cancer Hospital. The total cost was 168,518 yuan, of which 146,742 yuan had to pay for their own expenses. The fee deducted from the overall fund account was 18,038 yuan, or 10.7 percent of the total fee. As a result, health insurance accounts for only 10.7 percent of reimbursement.
We can see that the most expensive is the treatment, 124,114 yuan, out of pocket 120,308 yuan. Inspection fee 7600 yuan, more than 6700 from the Fanny Pack. Western medicine costs 23,166 yuan, out of pocket 13,000 yuan. This means that many important projects are self-financed.
This is the cost of treatment for cancer patients, so let's look at the cost of less serious diseases, the following is a list of the cost of treatment of lumbar disc herniation in the hospital. This screenshot is part of the bill for materials, which totals 16,669 yuan. The two most expensive items are disposable needles and radiofrequency catheter, which totals 15,200 yuan, all at one's own expense. Lumbar disc herniation surgery also need to pay so much money OH. Is not to refresh our understanding. We used to think that if we didn't get a serious disease like cancer, we could just get health insurance. In fact, health care is not nearly as affordable as we think.
So we need to buy our own commercial health insurance to make up for the lack of coverage. Commercial health insurance costs a few hundred dollars a year, low cost, high leverage. Is a basic security that everyone needs. But it requires a high level of physical health, must be bought as soon as possible.
(teach you to understand the hospital cost list, the proportion of health insurance refers to the proportion of their own expenses, Class A, the proportion of health insurance 0% , indicating that 100% of the reimbursement of health insurance. Class B, the proportion of health insurance is not the same, some out-of-pocket 15% , some out-of-pocket 10% . Class C, 100% coverage at your own expense.)