Individual industrial and commercial households with no employees in our city, part-time employees who have not participated in employee medical insurance in the employing unit, employees in new formats, self-employed (exempt) employees, other flexible employees or flexible employees who have participated in the basic medical insurance for urban and rural residents within the legal working age may voluntarily participate in the basic medical insurance for employees and pay the basic medical insurance premium. Flexible employees participate in the basic medical insurance for employees and enjoy the same level of medical treatment guarantee as the insured employees of this unit.
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What are the main changes in this policy adjustment?
First, the restrictions on participation in insurance have been liberalized.
1, relax the household registration insurance restrictions. We will implement the national and provincial requirements of "liberalizing the household registration restrictions for flexible employees to participate in basic medical insurance in their places of employment" and include flexible employees holding residence permits in this Municipality, Hong Kong, Macao and Taiwan into the scope of insurance.
2. Let go of the restrictions on basic old-age care. Flexible employees who do not choose to participate in the basic old-age insurance for enterprise employees may also choose to participate in the medical insurance for employees alone.
Second, the waiting time for treatment has been shortened.
For the first time, the waiting period of flexible employees (including those who pay for the interruption of flexible employment) participating in the basic medical insurance in this city will be shortened from the original 6 months to 3 months. For example:
Example 1
The insured Zhang San participated in medical insurance for the first time in our city in May 2022, and paid personal expenses as a flexible employee. Then May-July is the waiting period for treatment, during which he can enjoy the medical insurance treatment for employees in August.
Example 2
Li Si, the insured, once participated in employee medical insurance in Yixing as a flexible employee, but stopped paying in July 20021year, and paid again as a flexible employee in May 2022, so May-July is the waiting period for treatment. Those who pay in full and on time during the waiting period can enjoy employee medical insurance treatment in August.
What if the payment is interrupted during the transfer?
Can I return it?
1, the city has participated in the basic medical insurance for more than two years (including two years) (if the residents have paid in the medical insurance year, it will be counted as 1 year). Employees who change from residents' medical insurance to employees' medical insurance due to changes in their personal employment status can enjoy normal treatment after three months of interruption, and the medical insurance expenses during the interruption period are allowed to be paid back. After payment, the treatment during the interruption period can be enjoyed retroactively according to the regulations, and the personal account during the interruption period is needed. If the insurance is interrupted for more than 3 months, the insurance payment and treatment enjoyment policy shall be defined according to the relevant provisions of the first insurance. For example:
Example 1
The insured Zhang San paid the basic medical insurance for urban and rural residents in Yixing from 2020 to 20021. In March 2022, he joined the employee medical insurance as a flexible employee and paid the fee. Therefore, he can enjoy the treatment of on-the-job employees from March 2022, with no waiting period for treatment.
Example 2
Li Si, the insured, paid the basic medical insurance for urban and rural residents in Yixing from 2020 to 20021.He joined the medical insurance for employees as a flexible employee in March 2022 and paid the medical insurance premium in full from March 2022 to March 2022. Since June 2022, he has enjoyed the treatment of on-the-job employees without waiting period.
2, in the city to participate in employee medical insurance (including unemployed people in the period of receiving unemployment insurance benefits by the unemployment insurance fund to pay medical insurance premiums), in a co-ordination area after the cessation of employee medical insurance, transferred to the city, the above situation was interrupted for 3 months, during the interruption of medical insurance fees allowed to pay. After making up the basic medical insurance expenses during the interruption according to the regulations, it is regarded as continuous insurance and enjoying the waiting period treatment. After payment, the treatment during the interruption can be enjoyed retroactively according to the regulations, and the personal account during the interruption of payment is allocated according to the regulations; If the employee fails to pay back the medical insurance during the interruption period, it belongs to the employer who pays the employee's medical insurance, and enjoys the treatment in the second month after the unit declares. It belongs to the employee who participates in the employee's medical insurance as a flexible employee, and enjoys a waiting period of 3 months after paying the fee. Under the above circumstances, if the insurance interruption time exceeds 3 months, the insurance payment and treatment enjoyment policy shall be defined according to the relevant provisions of the first insurance. For example:
Zhang San, the insured, has been paying employee medical insurance normally. After the payment was stopped in June, 5438+October, 20221October, he joined the employee medical insurance again as a flexible employee in March, 2022, and paid the medical insurance fee in March, 2022. If Zhang San pays the medical insurance fee from June 65438+ 10 to February, he can enjoy the on-the-job treatment from June 65438+ 10 in 2022. If Zhang San chooses not to pay the medical insurance fee from June to February 2022, he will enjoy the treatment of on-the-job employees from June 2022.
3, in this city as a flexible employment personnel to participate in medical insurance for employees, arrears interrupted within 3 months, can enjoy normal treatment after payment, during the interruption of medical insurance costs are allowed to pay, and after payment, priority is given to make up for the amount of arrears in the early stage, during the interruption of treatment can be reissued according to regulations, and personal accounts during the interruption of payment are allocated according to regulations; If the arrears are interrupted for more than 3 months, the policy of payment and treatment enjoyment shall be defined according to the relevant provisions of Shoubao. For example:
Zhang San, the insured, has been insured as a flexible employee to pay employee medical insurance. Since June 5438 +2022 10, Zhang San has been unable to enjoy the overall medical insurance treatment for employees since February 2022. If Zhang San pays the arrears in full in March 2022, the treatment will be enjoyed retroactively from June 65438+ 10, 2022; If Zhang San still fails to pay the arrears in full by March, 2022, and the payment will be resumed from April, 2022, April-June will be the waiting period for treatment. If the payment is made in full and on time during the waiting period, the employees can enjoy the medical insurance treatment in July.
What is the payment standard for flexible employees this year?
In June 2022, 5438+ 10/the proportion of medical insurance contributions for flexible employees was 1 0% (the proportion of medical insurance contributions for flexible employees was reduced on the basis of the sum of unit contribution rate and individual contribution rate 1 percentage point) in June, 5438+ 10/month.