What kinds of medical insurance are there?

Medical insurance is generally divided into medical insurance for urban workers and medical insurance for urban and rural residents.

Employee medical insurance: paid by office workers and generally purchased by the company for employees.

Residents' medical insurance: if the elderly, children and other unemployed residents pay fees, they need to go to the local social security agency themselves.

Both employees' medical insurance and residents' medical insurance can enjoy medical treatment such as outpatient service and hospitalization.

So, what's the difference? How much does it cost? Taking Guangzhou medical insurance as an example, let's take a look at it separately:

1, employee medical insurance, how much to pay each year?

Employee medical insurance is paid by the company for us. The company will choose a payment base (493 1-24654 yuan in Guangzhou) according to our income, and then multiply it by the payment proportion (6.5% for the unit and 2% for the individual) to finally get the actual payment amount.

For example, Mr. A's medical insurance payment base is 10000 yuan, so the payment composition is as follows:

Unit monthly payment: 10000 × 6.5% = 650 yuan.

Personal monthly payment: 10000 × 2% = 200 yuan.

Monthly payment: 650 yuan +200 yuan = 850 yuan, that is, 10200 yuan per year.

In this 850 yuan, all 200 yuan paid by individuals goes into personal accounts and can be paid directly by credit card when seeing a doctor.

The money paid by the company will be included in proportion, and the older you are, the higher the proportion will be.

Take 30-year-old Mr. A as an example:

Unit monthly payment:10000×1%=100 yuan.

Individual monthly payment: 10000 × 2%= 200 yuan.

Monthly planned income: 300 yuan

Money that is not included in the personal account enters the social pooling account, that is, everyone pays a sum of money, which is uniformly controlled by the state. When we go to the hospital when we are sick, the state will reimburse us for some medical expenses.

2. How much medical insurance do residents pay each year?

Employees' medical insurance is paid monthly, and residents' medical insurance is paid annually, and it is guaranteed for one year at a time. Due to financial subsidies, it is generally not necessary to pay much. This year's payment standard is 288 yuan per person.

We can see that the premiums paid by the two kinds of medical insurance are very different each year, and the benefits enjoyed are naturally different, which will be analyzed later.

Step 3 Choose a designated hospital

After payment, you need to choose a designated hospital, commonly known as "one big and one small":

Larger hospitals: generally, they are second-and third-class big hospitals.

Small hospitals: most of them are community or first-class hospitals, and some are second-class hospitals.

For employees, children or students at school, you can choose 1 large hospital and 1 small hospital, while other adult residents can only choose 1 small hospital.

If you get sick in the future, you usually need medical treatment and reimbursement in designated hospitals. If you want to go to other hospitals, you need to go through the referral procedure, which is more troublesome.

Frequently asked questions about medical insurance 1. With medical insurance, do you still need to buy insurance?

Medical insurance benefits are getting better and better in recent years. Is medical insurance enough?

In fact, the positioning of medical insurance is only omnipotent, mainly used to solve the basic medical expenses. No matter which city's medical insurance, it is impossible to be perfect.

Through the following figure, we can intuitively see some shortcomings of medical insurance:

Image source: Deep Blue Treasure

(1) Three directory restrictions

Medical insurance has three catalogues of "drugs, diagnosis and treatment, service facilities", and medical expenses can only be reimbursed in the catalogue. Many specific drugs, high-tech inspection, VIP wards, etc. No reimbursement.

(2) Deductible and maximum compensation limit

Expenses below the deductible line and above the maximum compensation amount need to be paid by themselves, such as Guangzhou residents' medical insurance and 500 yuan, the deductible line of tertiary hospitals, with the maximum compensation of 230,000 yuan/year.

③ Limitation of reimbursement ratio

There is basically no 100% reimbursement for medical insurance, such as medical insurance for Guangzhou residents. Adult clinics can only be reimbursed 60%.

④ It is inconvenient to seek medical treatment in different places.

Guangzhou medical insurance is generally required to be used in "designated hospitals". If you want to go to other hospitals, you need a referral certificate. If you want to go to other provinces and cities to see a doctor, the procedures will be more troublesome, and the general reimbursement ratio will be reduced.

Therefore, although medical insurance benefits are good, it cannot cover all medical expenses.

The most pragmatic way is to match commercial insurance, so that you can be more confident in the face of illness.

2. How many years should medical insurance be paid?

Because urban and rural residents have paid for medical insurance for one year, employees can enjoy lifelong medical insurance benefits after they have paid for a certain number of years.

How long will it take? I have compiled the requirements of some popular cities:

Take Guangzhou as an example, you can enjoy lifelong medical insurance as long as you pay 15 years. If you only pay 10 years, there is no such benefit.

Since every city is different, if you want to know your city, you can call the social security hotline: 12333 for detailed consultation.

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