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Detailed rules for the implementation of the Interim Measures for the basic medical insurance for urban residents in Hebi City

In order to standardize the basic medical insurance for urban residents, these rules are formulated in accordance with the Interim Measures for the Basic Medical Insurance for Urban Residents in Hebi City (hereinafter referred to as the Measures).

I. General principles

Article 1 The "Measures" stipulate that "the whole city shall implement a unified medical insurance policy for residents and territorial management" refers to the unified implementation of the "Interim Measures for the Basic Medical Insurance for Urban Residents in Hebi City" and various supporting policies. The urban area is the overall planning area, Xunxian county is the overall planning area, Qixian county is the overall planning area, and the three overall planning areas operate independently.

Article 2 The "medical insurance year for residents is a natural year" as stipulated in the Measures refers to the period from 10/day to February 1 day.

Article 3 The term "different places" as mentioned in these Measures refers to areas outside the administrative area of Hebi City.

Article 4 The age calculation method of insured residents is that the age of residents at the time of enrollment is calculated to 65438+ 3 1 in February of the year of enrollment.

Second, the management responsibilities

Article 5 The municipal education department shall be responsible for the publicity, organization and payment of medical insurance for students in schools directly under the municipal government and children in kindergartens, and the counties (districts) schools and kindergartens shall be responsible for it.

The municipal civil affairs department is responsible for the identification of "low-income objects", and in conjunction with relevant departments such as finance, labor and social security, formulate specific definition standards for "elderly people over 60 years old in low-income families" and reasonably determine the scope of objects. Supervise the county (District) civil affairs departments to confirm the identity of relevant personnel, and provide a list of insured persons to the medical insurance agencies at the same level.

City Disabled Persons' Federation is responsible for the identification of "severely disabled students and children" and "severely disabled persons who have lost their ability to work", urging the county (district) Disabled Persons' Federation to confirm the identity of relevant personnel, and providing a list of insured persons to the medical insurance agency at the same level.

City and county medical insurance agencies are responsible for the publicity and training of residents' medical insurance in the overall planning area, the examination and approval of insurance participation, the production of medical insurance manuals and medical insurance IC cards, fund management, and the examination and payment of medical expenses.

District medical insurance agencies are responsible for the supervision of medical insurance business, the audit of insurance payment, the summary declaration of business information and the supervision of supporting financial subsidies for residents in sub-district offices and townships (towns) within their respective jurisdictions.

Sub-district offices and township (town) medical insurance agencies are responsible for household survey, registration, material review, information entry, medical insurance premium collection, medical insurance relationship change, medical insurance manual and medical insurance IC card issuance.

Third, registration and payment

Article 6 The "minimum target" as mentioned in the Measures refers to the residents who hold the "Minimum Living Security Certificate for Urban Residents in Hebi City" and are receiving the minimum living security; "Old people over the age of 60 in low-income families" refers to the middle-aged low-income family residents over the age of 60 confirmed by the civil affairs department; "Severe disabled persons" refers to those who hold the People's Republic of China (PRC) Disabled Persons' Card and are recognized by the Municipal Disabled Persons' Federation as having physical disability, hearing disability, language disability, intellectual disability, visual disability (excluding low vision), mental disability, etc.

Article 7 Urban residents shall provide their household registration book, original ID card and 1 recent bareheaded photos. "Minimum target" should also provide the original "Hebi city residents minimum living guarantee card". "Low-income families over 60 years old" should also provide the original certificate issued by the civil affairs department. "Severe disabled" should also provide the original "People's Republic of China (PRC) Disabled Card".

Article 8 Students in school and children in nurseries and kindergartens shall be insured by the education department as a whole, and other non-employed urban residents shall go through the registration and payment procedures at their neighborhood offices and township (town) medical insurance agencies with their families as units.

After schools and kindergartens complete the examination of students' and children's insurance data, information entry and insurance premium collection, municipal schools and kindergartens go to the municipal medical insurance agency to handle the insurance and payment procedures, and district schools and kindergartens go to the district medical insurance agency to handle the insurance and payment procedures.

Ninth street offices, township (town) medical insurance agencies, every year to the insured minimum target, low-income families over 60 years old, severely disabled publicity.

Tenth "Measures" to start the registration of the insured payment period for July 6, 2008 +0 to September 30, 2008, the insured residents to pay a one-time medical insurance fee for the second half of 2008 and the whole year of 2009. The insurance payment period after annual registration shall be implemented in accordance with the relevant provisions of the Measures.

Fourth, medical management.

Article 11 The Qifubiaozhun stipulated in the Measures refers to the expenses that individual residents should pay first before pooling funds to pay medical expenses. "Maximum payment limit (including hospitalization and outpatient medical expenses for major diseases)" refers to the maximum amount of hospitalization and outpatient medical expenses paid by the overall fund in a year.

"The Qifubiaozhun for the second and later hospitalization within one year is halved", which means that the insured residents are hospitalized twice or more within one year, and the medical expenses that meet the requirements of the first hospitalization exceed the Qifubiaozhun, and the second Qifubiaozhun is reduced by 50% according to the Qifubiaozhun of the hospital.

Twelfth insured residents need to live in different places for a long time, must carry the "medical insurance manual" and personal application, to co-ordinate the regional medical insurance agencies for the record, and limit the choice of two designated medical institutions as designated hospitals for medical insurance.

Article 13 If the insured residents need to be transferred to other medical institutions outside the overall planning area for medical treatment due to illness, except for emergency treatment, in principle, a referral form shall be issued by a medical institution above the second level (including the second level), which shall be audited and sealed by the medical insurance management department of the medical institution, signed by the dean in charge, and filed with the medical insurance agency in the overall planning area.

Article 14 If the insured residents need to be transferred to other medical institutions for diagnosis due to the medical conditions of the hospital, the hospital will issue a referral form, which can be referred after the consent of the medical insurance management department of the hospital, and the medical expenses that meet the requirements will be reimbursed by the original hospital according to the relevant regulations.

Fifteenth insured residents to non designated medical institutions for emergency treatment, should report to the regional medical insurance agencies within 3 working days after the treatment. If you need to continue hospitalization, you should be transferred to designated medical institutions for hospitalization in time after your condition is stable.

Article 16 The hospitalization expenses incurred by insured residents in non-designated medical institutions due to first aid shall be paid by individuals in advance, and after discharge, they shall be audited and reimbursed by the medical insurance agency in the overall planning area with relevant information, which conforms to the provisions of Articles 14, 15 and 21, paragraphs 3 and 4 of the Measures.

Seventeenth insured residents diagnosed as infectious diseases shall, in accordance with the principle of centralized management and centralized treatment of patients with infectious diseases, go to the infectious disease medical institutions designated by the health department for diagnosis and treatment.

Article 18 of the Measures stipulates that "accidental injury of students and children" refers to the injury caused to their bodies by external, sudden, unintentional and non-disease objective events. Students and children who are hospitalized due to accidental injuries shall report to the regional medical insurance agency within 5 working days from the date of hospitalization.

Article 19 In the year when the Measures came into effect, the insured residents enjoyed the residents' medical insurance benefits from July 1 day, and the maximum payment limit and amount of the residents' medical insurance fund were allocated to the outpatient account by half.

Twentieth insured residents should properly keep the medical insurance manual and medical insurance IC card. If it is lost or damaged, you should go through the formalities of reporting the loss and replacing it at the medical insurance agency of the insured place. If the insured residents die, their relatives should bring death certificates, medical insurance manuals and medical insurance IC cards to the medical insurance agency for cancellation.

Verb (abbreviation of verb) insurance relationship change

Article 21 The basic information of insured residents changes (from ordinary residents over 60 years old to low-income objects, severely disabled people and low-income families, from low-income objects and low-income families over 60 years old to ordinary residents, from residents under 18 years old to residents over 18 years old, household registration transfer, etc.). ), the insured residents should go through the change formalities at the medical insurance agency in the insured place in time.

Twenty-second residents who participate in medical insurance for urban workers are included in the basic medical insurance for urban workers, and the payment period of medical insurance for their residents is not counted as the payment period of basic medical insurance for urban workers.

Twenty-third urban residents who are employed after insurance should participate in the basic medical insurance for urban workers according to the regulations, and no longer enjoy the medical insurance benefits for residents, and the medical insurance premiums paid will not be refunded.

Twenty-fourth insured residents to settle abroad, join the army or die, the insurance premium paid will not be refunded, the insurance relationship will automatically terminate, and stop enjoying the basic medical insurance benefits for urban residents.

Fund management of intransitive verbs

Twenty-fifth every year before 65438+February 10, the district medical insurance agencies will transfer the financial subsidy funds at the corresponding level, medical insurance premiums paid by insured residents and interest to the special account of urban residents' medical insurance fund at one time; The county finance department will allocate the financial subsidy funds at the same level to the county residents' medical insurance fund account.

65438+ On February 20th every year, the municipal finance will allocate the municipal financial subsidy funds to the municipal and county medical insurance agencies respectively.

Seven. supplementary terms

Twenty-sixth of the "rules" by the municipal labor and social security department is responsible for the interpretation of.

Twenty-seventh these rules and measures shall be implemented simultaneously.