4hw.org: social security is closely related to our life. What's the difference between social security and business? How can they be reimbursed? Even after so many years of social security paid by small editors, you can't tell clearly. After reading the following three pictures, you can understand.
The connection and difference between social security and commercial insurance
1. What is social security
Social security, as a national welfare, aims to provide basic security for employees of enterprises and institutions. It includes five items: pension, medical treatment, work-related injury, unemployment and childbirth.
2. Characteristics of social security
Compulsory, wide coverage, and can only provide the most basic guarantee.
3. Current situation of social endowment insurance
At present, there are obvious differences in pension of different groups. Generally speaking, the pension standards of government & gt; institutions & gt; enterprises and civil servants are significantly higher than other social workers.
If the retirees of government organs and institutions work for a certain number of years, there is little difference between them before and after retirement. But for enterprise employees, pension is a big problem.
Take 60 year old male as an example, the monthly salary before retirement is 3325 yuan. If the accumulated time of paying social security is 15 years, only 758 yuan can be obtained after retirement, which is far from meeting the basic needs of life.
On the whole, the pension of enterprise employees after retirement can only get 38% of the pre retirement salary.
Social endowment insurance can guarantee the basic needs of the aged, but it can not guarantee the high-quality life of the aged. The supplement of commercial endowment insurance is particularly important for the vast majority of enterprise employees.
The current situation of social security medical insurance
1. Medical insurance
At present, social security medical insurance is divided into urban residents' basic medical insurance and rural cooperative medical insurance, which are collectively called urban and rural residents' basic medical insurance, namely medical insurance.
The calculation formula of medical insurance reimbursement amount is:
Reimbursement amount = (total amount - Category C self expense - Category B self payment - starting line) x reimbursement proportion
[note]:
1. Class C self expense: it refers to the class C drugs and class C diagnosis and treatment expenses in the medical expenses, which shall be paid by all insured patients at their own expenses.
2. Class B self payment: refers to the medical expenses in which class B drugs and class B diagnosis and treatment expenses shall be paid by the insured patients (20% of the medical materials shall be paid by the individual).
3. Starting line: it means that the patients have to bear a part of it first, and then the medical insurance will pay according to the specified proportion. The inpatient medical expenses below the initial payment standard shall be borne by the individual patient.
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2. Loopholes in medical insurance
General medical insurance has no life support
There are too many unfortunate cases in life, such as fire, plane crash, earthquake, etc. the medical insurance has no compensation for the death, just refund the money in the personal account to the family. Once the family economic pillar falls, how to solve the problem of the elderly's alimony, children's education and housing loan.
Medical insurance is obviously inadequate in accident protection
If the accident occurs on the way to work or at work, the work-related injury insurance in the social insurance can play a role of protection, but the social insurance is not responsible for other accidents, such as tourism, traffic accidents and liability accidents.
When serious illness and disability occur, social security can do nothing
Once a major disease occurs, many chemotherapy drugs are not covered by the medical insurance. In addition, the additional expenditure of health insurance, such as nutrition, nursing care and wage loss, cannot be solved.
Restrictions on medication and treatment scope
Only the drugs listed in the drug catalog of basic medical insurance can be used; 10% of the expenses shall be paid by the user for using the 'class B catalog' in the catalog; if it is beyond the scope, the medical insurance will not pay.
Starting standard and limit of payment proportion
For outpatient service and inpatient service, the individual payment shall be below the starting payment standard; for overall fund payment, the individual shall pay the part in proportion;
The large amount of mutual medical payment for outpatient and inpatient needs to be paid by individuals in proportion.
Medical insurance is the foundation, commercial insurance can only cover
A. the starting and self payment parts can be reimbursed for the second time through the outpatient reimbursement and inpatient allowance insurance of commercial insurance to reduce the expenses.
B. the content at own expense and the expenses beyond the top line can be compensated by the health insurance and serious illness insurance of commercial insurance. Once the diagnosis is made, the compensation shall be made immediately to help the treatment and make up the income.
Talking about medical insurance simply from V-Chart
A. for example, Mr. Wang, the social insurance hospitalization reimbursement is like this picture (draw "V");
B. This is the starting line for hospitalization. We need to bear the burden below the starting line (draw the starting line);
C. the part above the starting line is not all reportable, because social security also stipulates a top line. The part above the top line should also be borne by itself (draw the top line);
D. are all the parts above the starting line and below the top line reportable? No, because social security generally stipulates a 10% self payment ratio (draw the self payment ratio);
E. we all know that in the social insurance reimbursement, there are some self funded drugs, medical equipment and medical services, which also need to be borne by ourselves (draw the self funded part);
F. in our medical expenses, we need to pay for the part below the starting line, above the top line, the self paid part and the part at our own expense (Figure shadow). I will paint it as a shadow. The white part is the reportable part. You see, the shadow part is far greater than the white part;
As you can see from this picture, our huge medical expenses are far from enough only relying on social security. And as medical costs increase, the gap will grow. As Premier Zhu Rongji said, "social security is only a low-level insurance, not a guarantee". Therefore, it is necessary to purchase some commercial insurance as supplement.
This article is edited by Sihai life channel, aiming to spread knowledge, exchange and learn from each other, and improve the quality of public life. Please pay attention to Sihai life channel for more life information.