Are you approaching retirement and wondering how your employee medical insurance benefits will be handled? The process involves specific eligibility criteria, payment top-up options, and contribution calculations that every insured worker should understand.

Here is the official policy clarification for Taixing's employee medical insurance retirement benefits, covering everything from qualification requirements to payment schedules for major illness coordination funds and personal account allocations.

What are the conditions for processing medical insurance retirement benefit verification?

First, you must reach the medical insurance retirement age. For flexible employment personnel, this means reaching the statutory retirement age set by the state; for unit-employed workers, the age at which retirement procedures are lawfully processed serves as the medical insurance retirement age.

Second, you must have actual medical insurance contribution records in Taixing before reaching retirement age. Third, you must meet the cumulative contribution period requirement: male participants must have at least 25 years, and female participants at least 20 years, of cumulative contributions to basic medical insurance, including both recognized deemed contribution years and actual contribution years as stipulated by national regulations.

Fourth, you must pay a one-time major illness coordination medical insurance fee covering 15 years.

What if your cumulative contribution period is insufficient?

For those who have reached the statutory retirement age but lack sufficient cumulative contributions, there are two options to address the shortfall. The first option is to make a one-time lump-sum payment to cover the remaining years when processing the medical insurance retirement benefit verification. In 2026, the cap for this one-time basic medical insurance payment is 90,604 yuan.

For unit retirees, the calculation formulas are as follows: for male workers who need to reach 300 months of contributions, the top-up amount equals (300 - months already paid - months of deemed contribution years) multiplied by 10% and then multiplied by the contribution base. For female workers who need to reach 240 months, the top-up amount equals (240 - months already paid - months of deemed contribution years) multiplied by 10% and then multiplied by the contribution base.

For example, consider a male unit employee in Taixing in 2026 who has already paid 200 months with a contribution base of 4,952 yuan. His one-time top-up payment would be calculated as (300-200)*10%*4,952 = 49,520 yuan. If he has 2 years of deemed contribution, the calculation becomes (300-200-24)*10%*4,952 = 37,635.20 yuan.

For flexible employment retirees, the same 300-month and 240-month thresholds apply for men and women respectively, but the rate is 9% instead of 10%. The formula is: (target months - months already paid - deemed contribution months) multiplied by 9% and then multiplied by the contribution base.

For instance, a male flexible employment retiree in Taixing in 2026 who has paid 200 months with a contribution base of 4,952 yuan would pay (300-200)*9%*4,952 = 44,568 yuan as a one-time top-up. With 2 years of deemed contribution, this drops to (300-200-24)*9%*4,952 = 33,871.68 yuan.

The second option is to continue making monthly contributions as a flexible employment participant until the required contribution period is fulfilled.

How is the one-time 15-year major illness coordination fee calculated?

The calculation formula is straightforward: Major illness coordination fee = 180 * 0.8% * contribution base. For example, an insured worker in Taixing in 2026 with a contribution base of 4,952 yuan would pay 180*0.8%*4,952 = 7,130.88 yuan as a one-time major illness coordination payment at retirement.

What is the standard for personal account allocation after retirement?

For those who already enjoyed medical insurance retirement benefits before January 1, 2023, the personal account is allocated monthly at a fixed amount based on the amount credited in December 2022. For those applying for medical insurance retirement benefit verification after January 1, 2023, the personal account is allocated monthly at 5.5% of the pension amount determined at the time of verification. This rate remains provisional until the province issues new policy guidelines.