About medical insurance payment ratio and base in 2019

Medical insurance contribution ratio

1. Employer and individual contribution ratio

① Employer: The contribution ratio is 7.5% of the total salary of active employees;

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②Employees: The contribution rate is 2% of their salary income.

2. The payment base of the unit and individual employees

① The employer’s average monthly salary of the employees in the previous year is the payment base, and the individual employee’s payment base is the total monthly average salary of the employees in the previous year. The annual average monthly salary income is the monthly payment base.

② If the monthly payment base of the unit and individual employees is lower than 60% of the average monthly salary of employees in the previous year, 60% of the average monthly salary of employees shall be the payment base; if it is more than 300% higher than the average monthly salary of employees, Not included in the payment base.

3. The proportion of basic medical insurance premiums paid by the employer that are transferred to personal accounts

The State Council stipulates that the medical insurance premiums paid by the employer are divided into two parts, one part is used to establish a pool Fund; part of it is transferred to a personal account. The proportion transferred to the personal account is generally about 30% of the employer's payment. The specific proportion is determined by the coordinating region based on factors such as the payment scope of the personal account and the age of the employee.

4. If the employer and insured employees fail to pay or are in arrears with basic medical insurance premiums, the handling of personal accounts

The employer and insured employees should conscientiously fulfill their payment obligations and do not pay the premiums. Or when medical insurance premiums are in arrears, the funds in the employee's personal account will stop being credited. The remaining funds in your personal account can continue to be used.

New policy for personal medical insurance

1. Adjustment of the population covered by personal medical insurance

①The coverage of urban and rural residents’ medical insurance system includes existing urban residents’ medical insurance and new rural residents’ medical insurance All persons who should be insured (jointly) are covered, that is, all urban and rural residents except those who should be insured by the employee basic medical insurance are covered.

② Migrant workers and people with flexible employment are required to participate in the basic medical insurance for employees in accordance with the law. Those who have difficulties can participate in the urban and rural residents' medical insurance in accordance with local regulations.

2. How to raise funds for personal medical insurance

①Insist on multi-channel financing, continue to implement a financing method that mainly combines individual contributions and government subsidies, and encourage collectives, units or other social and economic Organizations provide support or funding.

② Reasonably divide the financing responsibilities of the government and individuals, and while increasing the government subsidy standards, appropriately increase the proportion of individual contributions.

3. Determination of financing standards for personal medical insurance

① All localities must comprehensively consider the needs of urban and rural residents for medical insurance and critical illness insurance, and reasonably determine unified financing for urban and rural areas in accordance with the principle of balancing fund revenue and expenditure. standard.

② In areas where there is a large gap between the individual payment standards of urban residents’ medical insurance and the new rural cooperative medical insurance, differential payment methods can be adopted and the gradual transition can be made in 2-3 years.

③The actual per capita financing and individual contributions after integration shall not be lower than the current level.

4. Personal medical insurance security benefits

① Follow the principles of moderate security and balanced revenue and expenditure, balance urban and rural security benefits, and gradually unify the coverage scope and payment standards.

②The Urban and Rural Residents Medical Insurance Fund is mainly used to pay for inpatient and outpatient medical expenses incurred by insured persons.

③Stabilize the level of hospitalization protection, and maintain the payment ratio of hospitalization expenses within the scope of the policy at around 75%.

④ Further improve outpatient coordination and gradually improve outpatient security levels.

⑤ Gradually narrow the gap between the payment ratio within the policy scope and the actual payment ratio.

5. When will the new personal medical insurance be implemented?

① All provinces (autonomous regions and municipalities) must make plans and arrangements for the integration of urban and rural residents’ medical insurance before the end of June, and clarify the timetable, road map to ensure that all policies and measures are implemented in place.

② Each coordinating region must issue specific implementation plans before the end of December.

Related reading

Guazhou Yuanquan Town’s urban residents’ medical insurance work highlights the “three focuses”

September 6th Recently, Yuanquan Town has vigorously carried out The collection work of urban residents’ medical insurance has been carried out, and the implementation of the work has been paid close attention to in three aspects.

The first is to promote publicity.

Towns and communities have carried out publicity, mobilization and deployment around residents’ medical insurance-related policies. ***12 small banners were hung, 56 scrolling slogans were posted on electronic screens, 198 promotional materials were posted in the community, more than 1,000 promotional materials were distributed, and publicity was carried out through various forms such as door-to-door explanations, so that everyone can better understand residents' medical care The importance and benefits of insurance have become well known to every household. The second is to work hard. In order to ensure that the medical insurance policy benefits the majority of residents and ensure that no missed reports are reported, community propagandists fully carry forward the hard-working spirit of "5+2" and "white plus black", mobilize door-to-door, and carry out medical insurance for the permanent and floating population in the jurisdiction. We visited and checked the situation, and provided door-to-door collection services for newly insured and renewed residents, so that the majority of residents have medical insurance and medical care. The third is to grasp responsibility. The town government established a leading group for basic medical insurance for urban residents with the deputy mayor as the team leader and the town social security office and the directors of each community neighborhood committee as members. It clarified the division of responsibilities, issued task indicators, and monitored the progress of the work on time. It implemented a "one-week" Responsibility mechanism of "one assessment every week" and "one report every week".

Through three measures, the medical insurance work for urban residents in Yuanquan Town is currently advancing steadily and progressing smoothly. ;