Shijiazhuang residents' medical insurance fixed point

Notice of General Office of Shijiazhuang Municipal People's Government on Printing and Distributing Detailed Rules for the Implementation of Basic Medical Insurance for Urban Residents in Shijiazhuang City (Trial) and Interim Measures for Large Supplementary Medical Insurance

Document of General Office of Shijiazhuang Municipal People's Government

Shi Zhengban [27] No.83

Notice of General Office of Shijiazhuang Municipal People's Government on Printing and Distributing Detailed Rules for the Implementation of Basic Medical Insurance for Urban Residents in Shijiazhuang City (Trial) and Interim Measures for Large Supplementary Medical Insurance.

People's governments of five districts in the city, administrative committees of high-tech zones, municipal government departments and municipal units:

Detailed Rules for the Implementation of Basic Medical Insurance for Urban Residents in Shijiazhuang City (for Trial Implementation) and Interim Measures for Large Supplementary Medical Insurance for Urban Residents in Shijiazhuang City have been approved by the municipal government and are hereby printed and distributed to you. Please earnestly implement them.

October 29th, 27

Detailed Rules for the Implementation of Basic Medical Insurance for Urban Residents in Shijiazhuang City (for Trial Implementation)

Chapter I General Provisions

Article 1 These Detailed Rules are formulated according to the Implementation Plan of Basic Medical Insurance for Urban Residents in Shijiazhuang City.

article 2 all non-employed residents who are not covered by the basic medical insurance system for urban workers (hereinafter referred to as employee medical insurance) in the urban areas of this Municipality (Xinhua District, qiaoxi district, Chang 'an District, Qiaodong District, Yuhua District and High-tech Development Zone) can participate in the basic medical insurance for urban residents in Shijiazhuang City (hereinafter referred to as residents' medical insurance). Primary and middle school students and kindergarten children who have registered permanent residence in rural areas and attend school with their parents in the urban areas of this city can voluntarily participate in the medical insurance for urban residents in Shijiazhuang city.

article 3 residents' medical insurance shall follow the principle of "low level, wide coverage, voluntary participation of the masses, territorial management and overall coordination", and focus on ensuring the medical needs of urban residents for serious illness in hospital and out-patient.

article 4 residents' basic medical insurance premiums (hereinafter referred to as residents' basic medical insurance premiums) shall be raised by combining individual or family contributions, government subsidies and social donations. The residents' basic medical insurance fund (hereinafter referred to as the residents' basic medical insurance fund) adheres to the principle of "fixed expenditure based on income, balance of payments and slight savings".

article 5 residents' medical insurance is under the charge of the municipal labor and social security bureau, assisted by the municipal finance bureau, the municipal health bureau, the municipal public security bureau, the civil affairs bureau, the municipal disabled persons' Federation, the municipal education bureau and the district governments, and handled by the municipal medical insurance management center (hereinafter referred to as the medical insurance center). The personnel, labor and social security bureaus of each district organize the labor and social security workstations in their respective jurisdictions to carry out residents' medical insurance work.

chapter ii responsibilities of management institutions

article 6 the municipal labor and social security bureau is the administrative department of residents' medical insurance in the city, and its main responsibilities are: (1) to formulate the overall plan of residents' medical insurance pilot. (two) to formulate policies and regulations for residents' medical insurance. (three) responsible for the implementation of the residents' medical insurance policy. (four) to supervise and guide the implementation process of residents' medical insurance. (five) responsible for the qualification examination and approval of designated medical institutions in urban areas. (six) to coordinate and deal with disputes related to residents' medical insurance. (seven) the implementation of medical insurance policies for residents of the units and individuals to implement rewards and punishments.

article 7 the municipal medical insurance management center (hereinafter referred to as the medical insurance center) is the agency for urban residents' medical insurance, and its main responsibilities are: (1) to conscientiously implement the policies and regulations of residents' medical insurance and put forward suggestions for improving and perfecting the residents' medical insurance system. (two) the preparation of residents' basic medical insurance fund budget and final accounts. (three) responsible for the collection, payment and management of the basic medical insurance fund for residents. (four) to select and determine the designated medical institutions for residents' medical insurance. (five) in conjunction with the price department to supervise and inspect the charging standards and drug prices of designated medical institutions. (six) responsible for the audit of medical expenses and related materials of designated medical institutions. (seven) entrusted by the Municipal Labor and Social Security Bureau to inspect, assess, reward and punish the implementation of residents' medical insurance policies by designated medical institutions, community labor and social security workstations and individuals. (eight) to be responsible for the summary and reporting of various financial, accounting and statistical statements of residents' medical insurance. (nine) to undertake the consultation and inquiry of community labor security workstations and residents on residents' medical insurance. (ten) responsible for the guidance of the city's residents' medical insurance business.

article 8 the personnel, labor and social security departments of each district are responsible for organizing the labor security workstations in their respective jurisdictions to carry out residents' medical insurance. The main duties of the labor security workstation are: (1) to conscientiously implement the policies and regulations on residents' medical insurance and do a good job in publicity and education. (two) responsible for the household survey of residents' medical insurance, insurance registration and the establishment and uploading of computer information. (three) to assist in the collection of medical insurance premiums paid by individual residents or families and to declare government subsidies for medical insurance for residents. (four) responsible for the preparation and reporting of the relevant statements of residents' medical insurance. (five) responsible for the distribution of residents' medical insurance cards, medical records and medical insurance manuals. (six) responsible for the reimbursement of residents' medical expenses. (seven) responsible for the inquiry of residents' medical insurance. (eight) to undertake other matters related to residents' medical insurance.

Article 9 Designated medical institutions shall set up medical insurance departments or designate special persons to be responsible for residents' medical insurance. Its main responsibilities are: (1) to undertake the medical service business of residents' medical insurance and formulate relevant management systems. (two) seriously implement the policies and regulations of residents' medical insurance, and do a good job in publicity and education. (three) responsible for the establishment of health records of residents, the registration and summary of medical treatment and medical consumption, and the implementation of computer information management in accordance with the provisions, timely transmission of information to the medical insurance center and submission of relevant statements. (four) responsible for undertaking the first diagnosis and referral of insured residents in accordance with the regulations; (five) responsible for the supervision and inspection of the implementation of residents' medical insurance policies and regulations by the staff of this unit. (six) to undertake other matters related to residents' medical insurance.

chapter iii scope and objects of protection

article 1 the scope and specific objects of residents' medical insurance include: (1) primary and secondary school students (including students from vocational high schools, technical secondary schools and technical schools). (two) primary and secondary school students and kindergarten children who are registered in rural areas and study with their parents in the urban areas of this city all the year round. (3) Non-school residents under the age of 18. (4) Residents of working and employment age (women aged 18 to 5, men aged 18 to 6) who have not participated in employee medical insurance, and hold the Disabled Persons' Certificate of the People's Republic of China, and belong to the first-and second-degree disabled residents; Useless units, and hold the "Shijiazhuang city residents minimum living guarantee card", to receive the minimum living guarantee for residents. (five) residents who have the ability to work within the age of employment and are unable to find employment with the support of government employment may voluntarily participate in residents' medical insurance, and must participate in employees' medical insurance after employment. (six) women over the age of 5 and men over the age of 6 residents.

article 11 residents' medical insurance coverage does not include the following persons: (1) servicemen. (2) Persons who retire in different places and enjoy pensions or pension benefits. (three) personnel who have participated in the new rural cooperative medical system.

Chapter IV Registration for Participation in Insurance

Article 12 Residents who meet the conditions for participation in insurance shall rely on their household registration book and its photocopy, their resident ID card and its photocopy, student handbook (student ID card), disability certificate and its photocopy, low guarantee and its photocopy, and primary and secondary school students whose household registration is in rural areas and their parents go to school in the urban area of this city all the year round, and children who are enrolled in kindergartens shall rely on their parents' Temporary Residence Permit and relevant certificates from the education department. Apply to the labor security workstation where my household registration or temporary residence permit is located to participate in residents' medical insurance, and fill in the "Registration Form for Urban Residents' Medical Insurance in Shijiazhuang City" according to my own situation, and handle the basic medical insurance registration (hereinafter referred to as insurance registration).

Article 13 When accepting residents' enrollment registration, approved payment standards and changes in basic medical insurance information for the record, labor security workstations and medical insurance centers shall strictly examine the relevant certificates approved by relevant departments provided by the applicants according to the provisions of Articles 1 and 12 of these Detailed Rules, and register and record those who meet the requirements.

Article 14 The age of residents shall be calculated until December 31st of the year of enrollment registration.

Article 15 The labor security workstation shall establish relevant computer information for each resident applying for insurance according to the information obtained from insurance registration and the content and format required by the medical insurance center, and transmit or submit relevant information to the medical insurance center in time.

Article 16 The medical insurance center shall review and confirm in time according to the information transmitted or submitted by the labor security workstation, and compile the Collection Plan of Medical Insurance Fees for Urban Residents in Shijiazhuang City and the Detailed List of Making and Distributing Basic Medical Insurance Cards, Medical Records and Medical Insurance Manuals for Urban Residents in Shijiazhuang City respectively according to the confirmed information, and feed them back to the corresponding labor security workstations as the basis for collecting basic medical insurance fees from residents and issuing medical insurance cards, medical records and medical insurance manuals.

Article 17 When a resident is employed, his household registration moves out of the city, dies, etc., he shall go through the formalities of terminating the medical insurance relationship and canceling the medical insurance card respectively. The medical insurance premium paid by me will not be returned. The labor and social security workstation should strictly examine the relevant documents submitted by the applicant, and go to the medical insurance center before the 1th of each month to meet the requirements. (1) If a resident changes from unemployed to employed and needs to terminate the medical insurance relationship, the following documents and materials shall be submitted: 1. Labor contract for employment. 2 medical insurance card. 3 Resident ID card. (2) If the household registration moves out of the urban area of this Municipality and the medical insurance relationship needs to be terminated, the following documents and materials shall be submitted: 1. Medical insurance card. 2, household registration transfer certificate and a copy. (3) If a resident dies, the medical insurance relationship will terminate automatically, and the immediate family members shall go through the cancellation procedures of the medical insurance card within 3 days, and the following documents and materials shall be submitted when handling: 1. Medical insurance card. 2. Death certificate.

chapter v collection of basic medical insurance premiums

article 18 the basic medical insurance premiums for residents are composed of individual or family contributions, government subsidies and social donations. Individual or family residents pay fees, which are collected by the medical insurance center and assisted by the labor security workstation; Government subsidy funds shall be collected by the Municipal Finance Bureau.

Article 19 The standards of residents' contributions and government subsidies are as follows: 1. Primary and secondary school students and non-school residents under the age of 18 are funded by 1 yuan per person per year (of which 6 yuan is used for accidental injury expenses). Among them, one or two disabled people and individual residents who receive urban minimum living allowance do not pay fees, and are fully subsidized by governments at all levels; Other individuals pay 5 yuan, and governments at all levels subsidize 5 yuan. Two, residents over the age of 18 financing standards for 3 yuan per person per year (including 6 yuan for accidental injury expenses). Among them: first-and second-class disabled people, individual residents receiving urban minimum living allowance do not pay fees, and they are fully subsidized by governments at all levels; Individuals over the age of 6 in low-income families pay 1 yuan, and governments at all levels subsidize 2 yuan; Female residents over 5 years old and male residents over 6 years old pay 2 yuan, and governments at all levels subsidize 1 yuan; Other individuals pay 25 yuan, and governments at all levels subsidize 5 yuan.

Article 2 When the standards of individual or family contributions and government subsidies need to be adjusted, the labor and social security department and the financial department will put forward an adjustment plan after the medical insurance center makes suggestions according to the income and expenditure situation, and report it to the Shijiazhuang Municipal People's Government for approval.

article 21 residents' basic medical insurance premiums shall be paid in advance and annually. Every year from September 1st to November 25th, it is the time for centralized registration, payment and change of residents' medical insurance information. Residents should be insured according to the prescribed time limit, and pay residents' medical insurance premiums in full and on time according to the prescribed standards. The start-up phase shall be the period of centralized registration and payment of insurance within two months from the date of promulgation of these detailed rules. Newborns and newly moved primary and secondary school students, non-school residents under the age of 18, can be insured and paid within 3 months from the date of household registration, but they are not handled within the centralized processing period. The basic medical insurance premiums for residents in that year are all paid by individuals or families.

Article 22 The medical insurance center shall set up residents' medical insurance fund income transition households in Shijiazhuang City Commercial Bank. Residents' individual or family contributions are collected by Shijiazhuang City Commercial Bank. Residents should pay to the income transition households at the business outlets of Shijiazhuang City Commercial Bank with their medical insurance cards or resident ID cards within the prescribed insurance registration payment period. At the end of the month, the medical insurance center will include the medical insurance fees paid by residents in the financial accounts, and the income households at the end of the month have no balance. Commercial banks should meet the payment needs of residents and timely transmit the individual payment information of residents to the medical insurance center.

Article 23 The medical insurance center shall compile the summary table of residents' payment by region according to the actual payment of residents, and the personnel, labor and social security bureaus of each district shall timely report the government subsidy funds for residents' medical insurance to the finance at the corresponding level, and the district finance bureau shall turn over the government subsidy funds at the corresponding level to the financial account of the medical insurance fund of the Municipal Finance Bureau within 2 days after receiving the request for funds; The Municipal Finance Bureau shall timely transfer the subsidy funds of the central, provincial and municipal governments into the financial accounts to ensure the normal use of the residents' basic medical insurance fund. The government subsidy funds for residents' medical insurance with financial burden at the city and district levels should be fully included in the fiscal budget at the same level.

Chapter VI Management and Use of Basic Medical Insurance Fund

Article 24 In this Municipality, residents in urban areas do not need to set up personal accounts for medical insurance, but use residents' basic medical insurance fees to set up basic medical insurance funds for insured residents.

article 25 the residents' basic medical insurance fund shall set up a special financial account, which shall be managed by two lines of revenue and expenditure, with separate accounts, independent accounting and special funds, and no unit or individual may occupy or misappropriate it.

article 26 the medical insurance center shall set up households paying for the residents' basic medical insurance fund, and prepare the application for the allocation of the residents' basic medical insurance fund every month according to the last month's expenditure, and the municipal finance bureau shall timely transfer the residents' basic medical insurance fund to the households paying for the residents' basic medical insurance fund in the medical insurance center to ensure timely settlement.

Article 27 The residents' basic medical insurance fund is exempt from all kinds of taxes and fees.

Article 28 Interest calculation of residents' basic medical insurance fund shall be carried out with reference to the interest calculation method of employee medical insurance fund.

Article 29 The residents' basic medical insurance fund is used to pay expenses other than the personal burden of residents' hospitalization and outpatient emergency rescue for diseases listed in the Catalogue of Emergency Rescue Diseases of Urban Residents' Basic Medical Insurance in Shijiazhuang City, outpatient radiotherapy (chemotherapy) for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency, phacoemulsification and intraocular lens implantation in cataract clinic, and outpatient use of anti-rejection drugs after organ transplantation.

Article 3 The threshold for residents' basic medical insurance fund to pay hospitalization medical expenses is determined according to the level of medical institutions, and the specific amount is as follows: 4 yuan is the first-class medical institution (including community health service center) when seeking medical treatment; 6 yuan when seeking medical treatment in a secondary medical institution; 9 yuan when seeking medical treatment in tertiary medical institutions; If the medical institution is not rated, it shall be implemented with reference to the level of medical institution with the same basic standard. A case of phacoemulsification and intraocular lens implantation in cataract clinic is regarded as a hospitalization, and its qifubiaozhun is the amount of medical institutions designated for medical treatment.

article 31 a resident's first hospitalization refers to the process of going through the formalities of admission and discharge. Emergency rescue and hospitalization are uninterrupted, which is regarded as a hospitalization. If the process of a hospitalization is cross-annual, the medical insurance year shall be determined according to the discharge settlement time.

Article 32 The medical expenses of residents who exceed the Qifubiaozhun are mainly paid by the residents' basic medical insurance fund, but individuals also have to bear a certain proportion, and the proportion paid by the residents' basic medical insurance fund is determined according to the level of medical institutions. The specific criteria are as follows: 7% of the first-class medical institutions (including community health service centers) seek medical treatment; 6% of medical treatment in secondary medical institutions; Medical treatment in tertiary medical institutions is 5%. The number of years for residents to pay the basic medical insurance premium is linked to the proportion of residents' basic medical insurance fund payment. For those who have been insured for more than 5 years, the proportion of residents' basic medical insurance fund payment can be increased by .5 percentage points for each additional year, but the maximum increase rate is not more than 1 percentage points. Residents' medical insurance and employees' medical insurance payment years are not regarded as each other. Malignant tumor (including