Take a look at the six major differences between employee medical insurance and
China has two major types of social medical insurance: the basic medical insurance for employees and the medical insurance for residents. Many people may not understand the differences between these two types of medical insurance. Which one is better?
There are at least six major differences between employee medical insurance and resident medical insurance:
1. Distinction in the compulsion of payment. If one is an employee of an organization, the employer is required to enroll the employee in the basic medical insurance for employees. This is stipulated by laws and regulations such as the Labor Law and the Social Insurance Law.
For special cases such as severely disabled individuals, registered impoverished households, or local minimum security families, the local government pays the premium for urban and rural residents according to regulations, and individuals do not need to pay.
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As for other situations, self-employed individuals can freely choose between employee basic medical insurance and urban and rural resident medical insurance. Other people can freely choose whether to participate in resident medical insurance.
2. Distinction in the amount of payment. The amount of payment for resident medical insurance is much less than that for employee medical insurance. Last year, the minimum individual payment standard for resident medical insurance was 380 yuan, while in many places, the payment amount for employee medical insurance was between 300 and 400 yuan per month. It's just that one is annual and the other is monthly. For example, in Qingdao, the minimum payment level for urban and rural resident medical insurance in 2023 is 395 yuan, but the minimum payment amount for self-employed individuals participating in employee basic medical insurance is around 360 yuan, and the minimum payment for organization employees is 424.2 yuan (including both the organization and the individual).
3. Distinction in the medical insurance personal account. Starting from the implementation of the outpatient cost-sharing mechanism for employee basic medical insurance in 2024, the general practice for in-service employees is to credit 2% of the payment base to the personal account, and for retired employees, it is around 2% of the average pension of the previous year according to the local implementation of the outpatient cost-sharing mechanism. Currently, there is still a significant difference in the amount of money recorded in the retirement personal accounts of medical insurance across different regions.
After retirement, there is also a personal account benefit, which is mainly used for various medical purposes such as personal medication, registration, hospitalization, etc.In accordance with national requirements, the residential medical insurance does not establish individual accounts, primarily to enhance the efficiency of fund usage and reduce fund redundancy.
④ Differences in reimbursement ratios. Regarding the reimbursement ratio for hospitalization, the reimbursement ratio for employee medical insurance generally starts at 80% to 85% or above, while the reimbursement ratio for residential medical insurance only starts at 50% to 70%. Although the difference in percentages may seem small, the actual difference from the perspective of personal self-payment is quite significant. For instance, in Qingdao, the reimbursement ratio for retired employees is 93% to 97%, while the reimbursement ratio for the first tier of residential medical insurance is only 65% to 70%. The personal self-payment ratio is 3% to 7% and 30% to 35%, respectively, which is a tenfold difference.
Additionally, in terms of outpatient reimbursement and other reimbursement benefits, employee medical insurance is also superior to residential medical insurance.
⑤ Differences in eligibility for retirement. Employee basic medical insurance is a type of insurance that, once paid for the required period and upon reaching retirement age, provides lifelong benefits without further payments. For residential medical insurance, annual payments are necessary and must continue until death.
⑥ Differences in coverage age. Residential medical insurance is irreplaceable for the protection of minors, as employee medical insurance is only available for adults. Generally, after reaching retirement age, one cannot participate in employee medical insurance unless they have previously paid and can make a one-time catch-up payment for the required years at retirement or continue to pay until the necessary years are met.
Considering the above, urban and rural resident medical insurance is a low-cost, low-benefit protection suitable for low- to middle-income groups. However, for better coverage, it is best to choose employee basic medical insurance. #Top Headline Creation Challenge# #Differences in Medical Insurance#
China has two major types of social medical insurance: the basic medical insurance for employees and the medical insurance for residents. Many people may not understand the differences between these two types of medical insurance. Which one is better?
There are at least six major differences between employee medical insurance and resident medical insurance:
1. Distinction in the compulsion of payment. If one is an employee of an organization, the employer is required to enroll the employee in the basic medical insurance for employees. This is stipulated by laws and regulations such as the Labor Law and the Social Insurance Law.
For special cases such as severely disabled individuals, registered impoverished households, or local minimum security families, the local government pays the premium for urban and rural residents according to regulations, and individuals do not need to pay.
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As for other situations, self-employed individuals can freely choose between employee basic medical insurance and urban and rural resident medical insurance. Other people can freely choose whether to participate in resident medical insurance.
2. Distinction in the amount of payment. The amount of payment for resident medical insurance is much less than that for employee medical insurance. Last year, the minimum individual payment standard for resident medical insurance was 380 yuan, while in many places, the payment amount for employee medical insurance was between 300 and 400 yuan per month. It's just that one is annual and the other is monthly. For example, in Qingdao, the minimum payment level for urban and rural resident medical insurance in 2023 is 395 yuan, but the minimum payment amount for self-employed individuals participating in employee basic medical insurance is around 360 yuan, and the minimum payment for organization employees is 424.2 yuan (including both the organization and the individual).
3. Distinction in the medical insurance personal account. Starting from the implementation of the outpatient cost-sharing mechanism for employee basic medical insurance in 2024, the general practice for in-service employees is to credit 2% of the payment base to the personal account, and for retired employees, it is around 2% of the average pension of the previous year according to the local implementation of the outpatient cost-sharing mechanism. Currently, there is still a significant difference in the amount of money recorded in the retirement personal accounts of medical insurance across different regions.
After retirement, there is also a personal account benefit, which is mainly used for various medical purposes such as personal medication, registration, hospitalization, etc.In accordance with national requirements, the residential medical insurance does not establish individual accounts, primarily to enhance the efficiency of fund usage and reduce fund redundancy.
④ Differences in reimbursement ratios. Regarding the reimbursement ratio for hospitalization, the reimbursement ratio for employee medical insurance generally starts at 80% to 85% or above, while the reimbursement ratio for residential medical insurance only starts at 50% to 70%. Although the difference in percentages may seem small, the actual difference from the perspective of personal self-payment is quite significant. For instance, in Qingdao, the reimbursement ratio for retired employees is 93% to 97%, while the reimbursement ratio for the first tier of residential medical insurance is only 65% to 70%. The personal self-payment ratio is 3% to 7% and 30% to 35%, respectively, which is a tenfold difference.
Additionally, in terms of outpatient reimbursement and other reimbursement benefits, employee medical insurance is also superior to residential medical insurance.
⑤ Differences in eligibility for retirement. Employee basic medical insurance is a type of insurance that, once paid for the required period and upon reaching retirement age, provides lifelong benefits without further payments. For residential medical insurance, annual payments are necessary and must continue until death.
⑥ Differences in coverage age. Residential medical insurance is irreplaceable for the protection of minors, as employee medical insurance is only available for adults. Generally, after reaching retirement age, one cannot participate in employee medical insurance unless they have previously paid and can make a one-time catch-up payment for the required years at retirement or continue to pay until the necessary years are met.
Considering the above, urban and rural resident medical insurance is a low-cost, low-benefit protection suitable for low- to middle-income groups. However, for better coverage, it is best to choose employee basic medical insurance. #Top Headline Creation Challenge# #Differences in Medical Insurance#