What Are the Social Security Limits?

Social security fees include various social security fees paid in accordance with state regulations, employee housing provident fund, and expenses for retirees who have not yet been transferred. Also called "Social Security".

Social security fee

What is social insurance? What types are included? ^[1]

1. Security: to protect the basic life of workers after they lose their ability to work, and to maintain social stability.

2. Legality: National legislation, mandatory implementation.

3. Mutual benefit: redistribution of income.

4. Welfare: Social insurance is not for the purpose of profit. It solves the biggest social security problems with the least cost and belongs to the nature of social welfare.

5. Universality: The scope of implementation of social insurance is wide.

All levels

As of December 31, 2009, basic endowment insurance for staff of state agencies and public institutions, the monthly payment of the unit is based on 34% of its actual monthly salary, and the personal payment is based on 1% of its actual monthly salary. Pay monthly.

The basic old-age insurance premiums paid by enterprises are

Basic pension = basic pension + personal account pension

The basic pension is the monthly salary level of the employee for the current year * 20%; the personal account pension is the number of months corresponding to the principal and interest of the personal account and / or the retirement age.

Example (take Beijing as an example):

Dahua, 45 years old, male, paid 15 years, retired in 2015.

The average monthly salary of employees in 2001 was 2,162 yuan;

The average monthly salary of employees in 2015 was 4,680 yuan.

Basic pension received:

4680 * 20% (basic pension) + [(2162 + 4680) ÷ 2] × 8% × 12 × 15 (personal account pension) * 1/120 = 936 yuan + 410.52 yuan

= $ 1346.52

Analysis: The basic pension received is only the most basic cost of living security.

Basic medical insurance is a type of social insurance that is formulated by the government to protect the basic medical needs of urban employees, to make reasonable use of health resources, and to improve the social security system.

8. Who needs to pay premiums for basic medical insurance? How is basic medical insurance paid?

State-owned enterprises, urban collective enterprises, foreign-invested enterprises, urban private enterprises and other urban enterprises and their employees, state agencies and their staff, public institutions and their employees, private non-enterprise units and their employees, social organizations and their full-time personnel, Urban individual industrial and commercial households.

Enterprises pay 6% of the total wages of employees; employees pay 2% of the average monthly salary of the previous year.

What are the basic medical insurance payment items? How to pay?

There are four main restrictions on the scope of medical services that can be paid for basic medical insurance:

The first is to seek medical treatment and purchase medicines at designated optional designated medical institutions and designated pharmacies;

The second is to meet the scope of the basic medical insurance drug catalog;

The third is to meet the scope of basic medical insurance diagnosis and treatment items;

The fourth is to meet the scope of basic medical insurance medical service facilities standards.

Medical expenses incurred in compliance with the above provisions will be paid by the Basic Medical Insurance Fund in accordance with regulations.

Example 1: General medical expenses (take Beijing as an example)

Xiaohua, 30 years old, spent 5600 yuan for outpatient treatment, and later spent 36,000 yuan in a tertiary hospital for a total of 41,600 yuan.

Reimbursement:

1) Outpatient reimbursement: (5600 yuan-2000 yuan) × 50% = 1800 yuan

Note: "2000 yuan" is the outpatient payment line. "50%" is the reimbursement ratio.

2) Hospital reimbursement:

(10,000 yuan-1300 yuan) × 85% = 7395 yuan

Note: "1300 yuan" is the starting line. "85%" is the reimbursement ratio.

(30,000 yuan-10,000 yuan) × 85% = 17,000 yuan

Note: According to the regulations of Beijing, more than 10,000 to 30,000 yuan will be reimbursed at 85%.

(36,000 yuan to 30,000 yuan) × 90% = 5400 yuan

Note: According to the regulations of Beijing, more than 30,000 to 40,000 yuan will be reimbursed at 90%.

Total: 29,795 yuan

Total basic medical reimbursement:

Outpatient + inpatient = 1800+ (7395 + 17000 + 5400) = 31595 yuan

Total personal payout:

Outpatient + hospitalization = (5600-1800) + (36000-29795) = 10005 yuan

Example 2: Major Medical Expenditure (Taking Beijing as an Example)

Dahua, 40 years old, spent 50,000 yuan for severe illness clinics, and later spent 180,000 yuan in hospitalization in tertiary hospitals, with a total of 230,000 yuan.

Reimbursement:

1) Outpatient reimbursement:

(50,000 yuan-2000 yuan) × 50% = 24,000 yuan

Note: "2000 yuan" is the outpatient payment line. "50%" is the reimbursement ratio.

Because the maximum limit of basic medical outpatient expenses in Beijing is 20,000 yuan, the actual payment is 20,000 yuan, and the others are self-paid.

2) Hospital reimbursement:

(10,000 yuan-1300 yuan) × 85% = 7395 yuan

Note: "1300 yuan" is the starting line. "80%" is the reimbursement ratio.

(30,000 yuan-10,000 yuan) × 85% = 17,000 yuan

Note: According to the regulations of Beijing, more than 10,000 to 30,000 yuan will be reimbursed at 85%.

(40,000 yuan to 30,000 yuan) × 90% = 9,000 yuan

Note: According to the regulations of Beijing, more than 30,000 to 40,000 yuan will be reimbursed at 90%.

(70,000 yuan to 40,000 yuan) × 95% = 28,500 yuan

Note: 90% will be reimbursed for the part exceeding 40,000 yuan to the maximum limit according to Beijing regulations.

3) Mutual Aid Funds for Large Medical Expenses:

(180,000 yuan-1300-70000) yuan × 70% = 76090 yuan

Note: According to Beijing regulations, reimbursement is 70%, and the maximum limit is 100,000 yuan.

Total: 61895 yuan

Total basic medical reimbursement:

Outpatient + inpatient + large amount of medical treatment = 20000 + 61895 + 76090 = 157985 yuan

Total personal payout:

Outpatient + inpatient + large amount of medical treatment = 230000- (50000-20000)-

(70000-61895) -76090 = 72015 yuan