Medical insurance here refers to social medical insurance.

When seeing a doctor with a patient, doctors often take the patient's medical insurance status into consideration.

Here are some basic knowledge about social medical insurance.

Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide workers within the coverage with basic medical needs when they fall ill.

The basic medical insurance fund consists of a pooled fund and individual accounts.

All basic medical insurance premiums paid by individual employees are included in their personal accounts; basic medical insurance premiums paid by employers are divided into two parts, one part is transferred to the personal account, and the other part is used to establish a pooling fund.

The composition of social coordinated medical insurance is: the payment base is M: employee salary income + allowance.

The unit pays 8% M per year; individual employees pay 2% M per year; the unit pays 8%---6.6% to 7% goes into the overall account (1% to 1.4% goes into the personal account)---hospitalization expenses; individuals pay 2%

---2% goes into the personal account (plus 1% to 1.4% paid by the unit) ---outpatient expenses.

Assume: A 30-year-old employee of a certain unit has an annual income of 20,000 yuan. After applying for social medical insurance, the unit pays 1,600 yuan per year; the employee himself pays 400 yuan per year.

The personal account consists of two parts: 400 yuan paid by the individual + 1,600 yuan paid by the unit (according to regulations, 1% for those under 35 years old; 1.4% for those over 35 years old). The remaining 1,440 yuan will all go into the overall account.

Note: Hospitalization expenses are reimbursed from the overall account, and the amount is the same for everyone; outpatient expenses are deducted from the personal account (i.e., medical insurance card), and each person is different.

Features: It has the characteristics of "low level and wide coverage". The payment is based on the cost that most low-level units and individuals can afford. It widely covers all units and employees in cities and towns. Employees of different types of units can enjoy basic medical insurance.

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After the insured completes the payment period, they can enjoy it for life.

Secondly, basic medical insurance has the characteristics of "both parties bear the responsibility and combines accounting"; it is based on the principle of "determining expenditure based on revenue and balancing revenue and expenditure".

Advantages: Enjoy treatment according to unified standards.

The same access conditions, the same charging standards, and the same benefits, there is no difference between high and low.

Employees' outpatient expenses can be deducted from their personal accounts, and after the deduction is completed, the employees will pay by themselves.

Employee hospitalization expenses are reimbursed on a proportional basis: 86% of expenses for expenses of 10,000 yuan are reimbursed by tertiary hospitals; 88% of expenses for expenses of 10,000 to 20,000 yuan are reimbursed by tertiary hospitals; 92% of expenses for expenses of 20,000 to 40,000 yuan are reimbursed by tertiary hospitals.

If the employee does not fall ill for several consecutive years, the personal account funds can be accumulated and rolled over.

Disadvantages: There is a basic deductible for each hospitalization, which is: 500 yuan for first-level hospitals, 750 yuan for second-level hospitals, and 1,000 yuan for third-level hospitals. These expenses need to be borne by the employees themselves.

Category A drugs and Category B drugs are reimbursed on a proportional basis. Imported drugs are not reimbursed. If you exceed the coverage limit of 40,000 yuan, you have to pay for it yourself.