What Is a Medicare Levy Surcharge?

Medical insurance premiums are formed by the joint contributions of employees, units and the state in a certain proportion of contributions. Participants can get some or all of the reimbursement amount when they see a doctor for illness. It embodies the principle of equality between individual rights and obligations. The right to reimbursement is only available if you pay the full amount of medical insurance premiums on time.

Medical insurance premium

Medical insurance premiums are formed by the joint contributions of employees, units and the state in a certain proportion of contributions. Participants can get some or all of the reimbursement amount when they see a doctor for illness. It embodies the principle of equality between individual rights and obligations. The right to reimbursement is only available if you pay the full amount of medical insurance premiums on time.

Chinese name

Medical insurance premium

Object

Employees, units and countries

in principle

Personal rights and obligations

Standard

basic medical insurance

I. Payment Standards ^[1]

I. Accounting Treatment ^[1]

The settlement procedures for medical expenses in different places are different, the settlement standards and methods are different, and the payment methods are different, but they can be summarized as two settlement methods. One is the prepayment system and the second is the postpayment system. The prepayment system means that before the medical service occurs, the medical insurance institution pays the fees to the designated medical institution or the employer in advance according to certain standards. In the case of the prepayment settlement method, the medical insurance institution shall pay the required amount to the medical insurance institution and the employer through the "provisional payment" account according to the employee medical insurance contract signed with the designated medical institution and the employer or according to the relevant regulations of the local government. Debit the account of "Temporary Payment" and credit the account of "Bank Deposit-Expenditure Account". In the regular reimbursement, according to the prescribed medical insurance premium expenditure scope and standards, review the medical insurance expenditures of the medical insurance recipients and the employer's medical insurance reimbursement amount, and debit the "social medical expenses" and "personal account medical expenses" "," Retired Medical Fund Expenditure "subjects, credit" Provisional Payment "subjects. The post-payment system refers to the method of paying for medical services based on the cost of the service or the amount of the service. If the post-payment settlement method is adopted, advance payment shall be made by the medical institution and the employer. When reimbursing, the medical insurance institution shall review according to the prescribed expenditure scope and standards, and pay the payment to the designated medical institution and the employer. "Fund Expenditure", "Personal Account Medical Fund Expenditure", "Retired Medical Fund Expenditure" subjects, and the "Bank Deposit-Expenditure Household" subject will be credited.

[Example 1] A social medical insurance institution implements a prepayment system for the payment of medical expenses of a medical institution, with a prepayment of 70,000 yuan. Make accounting entries as follows:

Borrow: temporary payment-× hospital 70000

Loan: bank deposits-spending households 70000

[Example 2] Following on from the previous example, the medical expenses of the employees participating in the insurance in the month for medical treatment in the hospital should be borne by the social pool medical fund of 43,000 yuan, and the portion that should be borne by the personal account is 12,000 yuan. Review and reimburse for the following accounting entries:

Borrowing: Expenditure for social pooled medical funds-Expenditure for social pooled medical expenses 43,000

Personal Account Medical Fund Expenditure-Personal Account Medical Expenditure 12000

Loan: temporary payment-× hospital 55000

[Example 3] An employer comes to a social medical insurance institution to reimburse medical expenses with the receipts and details of the medical expenses of the insured employees. After review by the social medical insurance institution, the part that should be paid by the personal account medical fund is 50,000 yuan. In addition, because the employee Wang Li's own medical expenses ratio exceeds the prescribed limit, according to the stipulated reimbursement ratio, the social unified medical fund should reimburse the medical expenses of 2,400 yuan. Pay by bank deposit. Based on the relevant vouchers, make the following accounting entries:

Borrowing: Expenditure for social pooled medical funds-Expenditure for social pooled medical expenses 2400

Personal Account Medical Fund Expenditure-Personal Account Medical Expenditure Expenditure 50000

Loan: bank deposits-spending households 52400

[Example 4] Zhang Lin, a retired employee of an enterprise, reimburses medical expenses of 8,000 yuan. After investigation, the medical fund of the retired employee's medical fund has only 5,000 yuan. The rest is reimbursed by the enterprise. Medical insurance institutions make the following accounting entries:

Borrow: Retired Medical Fund Expenditure-× Enterprise 5000

Loan: bank deposits-expenditure households 5000