Is there a limit on the number of days in hospital for medical insurance? Expensive and difficult to see a doctor has always been a problem in our country. The emergence of urban medical insurance can alleviate this situation and greatly reduce the family pressure of poor families. So do you have any questions about medical insurance?
It has been more than a year since the birth insurance and basic medical insurance of employees were combined in 12 regions. For some time, online articles about health insurance and maternity insurance have been spreading on some online platforms, causing public discussion. "Medical insurance stipulates that hospitalization cannot exceed 15 days" before seeing a doctor, you should transfer to a community hospital, otherwise you will not be reimbursed. "Male employees and female employees who no longer have children do not need to pay for birth insurance" & hellip; & hellip; are these statements in line with national policies, and what misunderstandings and Misreading exist? The reporter interviewed the relevant principals of the Ministry of human resources and social security, experts and scholars, and analyzed the correlation between medical insurance and birth insurance Policy.
Go to the community hospital first and then transfer to another hospital before reimbursement. According to the medical insurance, can't you stay for more than 15 days?
Response: the first visit at the grass-roots level is not compulsory, and there is no limit on hospitalization expenses and days for medical insurance
'the first visit at the grass-roots level is not compulsory. Patients are free to choose medical institutions designated by medical insurance for medical treatment without any referral procedures. Chen Qiulin, director of the Social Security Research Office of the Institute of population and labor economics, Chinese Academy of Social Sciences, said that the first diagnosis and two-way referral at the grassroots level are mainly realized through reimbursement leverage. The reimbursement rate of primary diagnosis and treatment is higher than that of large hospitals, so as to encourage patients to go to the primary diagnosis and treatment at the primary level to achieve hierarchical diagnosis and treatment, but the primary diagnosis at the primary level is not mandatory.
'the medical insurance policy has never stipulated the limit of hospitalization expenses for the insured. "Chen Qiulin said," the competent department of health and health has an assessment on the average cost of medical institutions and a regulation on the average length of stay. The medical insurance department controls the total medical expenses of medical institutions and limits the price of some diseases. The corresponding diseases cannot exceed a certain limit, but these are all aimed at medical institutions. They are total amount control, not individual patients. Even if the hospital exceeds the medical insurance limit, the insured will not be allowed to pay the medical expenses by themselves. '
There is a saying on the Internet: 'there is a limit on the number of days of hospitalization for medical insurance, and the limit on 15 days of hospitalization is the iron rule. "In response, Chen Qiulin said," medical institutions have an average length of stay assessment, and the limited length of stay is not for a single patient. In reality, some patients stay in hospital for a long time. In order to reduce the average length of stay, some hospitals will require patients to leave the hospital and then be hospitalized again. But there is no regulation in the health care sector. '
The balance of 3 months after medical insurance is cut off is cleared, and the money in individual account can be used freely?
Response: the individual medical insurance account will not be cleared, but the scope of payment is limited and cannot be cashed out
Wang Zhen, director of the public Economy Research Office of the Institute of economics of the Chinese Academy of Social Sciences, introduced that, taking the medical insurance of employees as an example, the system of overall planning and personal account was implemented, and after the continuous payment of a certain number of years (generally 25 years, 20 years or 15 years), retirement can enjoy treatment without payment. Three months after the cut-off, the calculation of the continuous payment period of the overall planning account needs to start again, and the original payment period is cleared. However, some regions also allow to make up payment when retiring, so as to reach the continuous payment period, 'the money in the individual account is all own and will not be cleared. '
'for urban and rural residents' medical insurance, the pay as you go system is implemented, and there is no individual account, so there is no statement of zero clearing. 'Wang Zhen said that some regions stipulated that after a certain period of time (different times in different regions), they would no longer enjoy the treatment and could not be reimbursed, but they could enjoy the treatment in the next month as long as they paid again.
The individual account of medical insurance card belongs to the individual, but its fund composition is not only the individual payment, but also the part of the overall plan fund. Therefore, it should be used strictly according to the payment scope of the individual account, and it is not allowed to cash out or exchange items at will. Personal accounts can only be used for medical purposes. Chen Qiulin said that in some provinces and cities, medical insurance accounts can be used for family members to help each other, and medical insurance fees for spouses, children and parents can be paid, which are only limited to immediate family members and spouses, and can not be lent to others to swipe their cards at will.
Many places have increased maternity bonus leave, and the employee's maternity allowance has increased accordingly?
Response: at present, the state has no uniform provisions on maternity bonus leave and allowance
The benefits of maternity insurance include reimbursement of medical expenses such as hospitalization and childbirth incurred during childbirth, and maternity allowance for female employees during maternity leave. "Wang Zhen said that after the employing unit participated in the maternity insurance, the medical expenses and wages during the maternity leave of the female employees of the unit did not need to be borne by the unit, but were paid by the maternity insurance fund.
According to the person in charge of the medical insurance Department of the Ministry of human resources and social security, maternity allowance is a part of maternity insurance benefits, which is paid according to the average monthly payment of the employer divided by 30 days and multiplied by the days of maternity leave. The actual situation is different in different parts of the country, and the time limit for applying for maternity insurance is also different. There are three months, six months and one year. It is generally required to apply within the prescribed time limit. In some areas, we have tried to combine birth insurance with basic medical insurance for employees, strengthen the fund management of birth insurance and medical insurance, and expand the coverage. After the combination, the treatment of birth insurance will remain unchanged. '
The person in charge said that couples who have children in line with the laws and regulations can be rewarded with extended maternity leave or other welfare benefits. Due to the different actual conditions in different regions, there is no unified provision for maternity bonus leave. The newly increased maternity bonus leave is included in the scope of maternity allowance payment, and its salary is paid by the maternity insurance fund according to the payment standard of maternity allowance. But there are seven or eight provinces and cities in the country that have not extended the maternity bonus leave, nor increased the employee's maternity allowance.
Does male worker and female worker that no longer bear need to pay birth insurance?
Response: maternity insurance is compulsory, and the employer shall pay for all employees
Some public and business operators believe that "male employees do not have children, so the birth insurance has nothing to do with male employees." the birth insurance is only useful when they have children, and they can not pay if they no longer have children. ".
To this end, Wang Zhen said, birth insurance is a statutory social insurance, compulsory insurance. The corresponding risk of maternity insurance is the risk of employing female employees in enterprises, and it is the risk of enterprises, not the risk of employees. Maternity insurance only needs to be paid by the enterprise. No matter whether the employer has female employees or not, and whether the female employees are in the childbearing period, the employer shall participate in the childbearing insurance for its employees. The payment of maternity insurance shall be borne by the unit, and the individual does not need to pay. Therefore, even if a unit is all male employees, it should also participate in maternity insurance; if female employees no longer have children, the unit should continue to participate in maternity insurance.