Beijing serious illness medical insurance

Medical insurance system for serious illness of the elderly in Beijing;

Article 1 In order to ensure the smooth implementation of the serious illness medical insurance system for the urban elderly without medical security (hereinafter referred to as "urban elderly") in this Municipality, these Measures are formulated in accordance with the Implementation Opinions of Beijing Municipality on Establishing the Serious Illness Medical Insurance System for the Urban Elderly and Students and Children without Medical Security (J.F. [2007] 1 1) and with reference to the relevant provisions of this Municipality's basic medical insurance.

Article 2 The scope of personnel participating in medical insurance for serious illness of the elderly in cities and towns of this Municipality includes:

(a) residents who have non-agricultural household registration in this Municipality and are not included in the basic medical insurance coverage for urban workers, who have reached the age of 60 and women have reached the age of 50;

(two) the elderly who enjoy the minimum living guarantee for urban residents in this city;

(three) the elderly in cities and towns who enjoy the subsidies for the living difficulties of urban residents in this city;

(four) according to the city's urban poor medical assistance measures to enjoy medical treatment of early retirees;

(five) according to the city's urban poor medical assistance measures to enjoy medical treatment of retired old activists provided by the neighborhood committee.

The above persons are collectively referred to as the "Insured".

Article 3 The insured shall go through the payment procedures of medical insurance for serious illness of the elderly in cities and towns from September/KLOC-0 to June 11.30 every year, and pay the medical insurance premium for serious illness of the following year in one lump sum according to the payment standard.

Article 4 Persons who meet the conditions of insurance in that year shall, within 90 days from the date of reaching the age of insurance, go through the formalities of medical insurance for serious illness of the elderly in cities and towns with their household registration books, and pay the medical insurance premium of that year in one lump sum according to the payment standard. Enjoy the medical insurance treatment for serious illness of the elderly in cities and towns from the month after the insured payment, and enjoy the treatment until 65438+February 3 1 of that year.

Article 5 Insured persons who meet the provisions of Items (2), (3), (4) and (5) of Article 2 of these Measures shall be exempted from the medical insurance premium for serious illness that should be paid by individuals. The above-mentioned insured shall submit the following relevant documents in addition to the household registration book when handling the insurance payment formalities at the social security office where the household registration is located:

(a) to enjoy the minimum living guarantee for urban residents in this Municipality, and submit the "Beijing Minimum Living Guarantee Certificate for Urban Residents";

(two) to enjoy the living allowance for urban residents in this Municipality, and submit the "Certificate of Living Allowance for Urban Residents in Beijing";

(3) Retirees who enjoy medical treatment according to the medical assistance measures for the urban poor in this Municipality shall submit the Medical Handbook for Retired Persons in Beijing;

(four) according to the city's urban poor medical assistance measures to enjoy medical treatment of retired old activists in neighborhood committees, submit the "medical certificate of retired old activists in Beijing neighborhood committees".

Article 6 Medical insurance for serious illness of the elderly in cities and towns is from June 65438+ 10/to June 65438+February 3 1.

Seventh insured persons can pay the medical insurance premium for serious illness of the elderly in cities and towns in the form of cash or bank withholding. After the insured person has gone through the insurance payment procedures, he/she will choose a designated medical institution and receive the Handbook of Serious Illness Medical Insurance for the Urban Elderly in Beijing. If the insured exceeds the time limit for handling the insurance payment, he will not handle the insurance payment procedures for the next year or the current year.

Article 8 If the insured person has paid the medical insurance premium for the following year and died before June 65438+February 3 1 of that year, his family members shall go through the refund formalities with the death certificate issued by the medical institution or the public security department.

Article 9 The following medical expenses incurred by the insured that conform to the list of basic medical insurance drugs, the list of diagnosis and treatment items and the scope of medical service facilities in this Municipality shall be paid by the urban elderly medical insurance fund according to regulations:

(a) hospitalization expenses;

(2) Outpatient medical expenses for taking anti-rejection drugs (hereinafter referred to as "special diseases") after radiotherapy and chemotherapy, renal dialysis and kidney transplantation (including combined liver and kidney transplantation) for malignant tumors;

(three) emergency rescue observation and hospitalization, medical expenses within 7 days before hospitalization observation;

(four) medical expenses within 7 days before death in case of death under observation of emergency rescue.

Tenth urban elderly medical insurance fund shall not pay the following medical expenses:

(a) to seek medical treatment in a medical institution other than my designated medical institution, except for emergency hospitalization;

(2) Injuries caused by traffic accidents, medical accidents or other liability accidents;

(three) due to drug abuse, fighting or other illegal acts;

(four) due to suicide, self-mutilation, alcoholism and other reasons to receive treatment;

(5) being treated abroad or in Hongkong, Macao Special Administrative Region or Taiwan Province Province;

(six) according to the provisions of the state and this Municipality shall be borne by individuals.

Eleventh urban elderly medical insurance fund in a medical insurance year, the first hospitalization Qifubiaozhun is 1300 yuan; Qifubiaozhun for the second and subsequent hospitalization is 650 yuan.

Twelfth insured medical expenses, Qifubiaozhun above part by individuals and urban elderly medical insurance fund in proportion to share. Among them, the urban elderly medical insurance fund pays 60%, and the personal burden is 40%. In a medical insurance year, the maximum cumulative payment limit of urban elderly medical insurance fund is 70 thousand yuan.

Thirteenth insured hospitalization for 90 days as a settlement period. No more than 90 days shall be settled according to the actual hospitalization days; If it is more than 90 days, it will be settled once every 90 days, and it will be regarded as the second hospitalization after settlement.

Fourteenth insured outpatient treatment of special diseases, according to each medical insurance year as a settlement cycle. If the special disease is approved in that year, the settlement period shall be from the date of approval to the annual deadline of this medical insurance.

Fifteenth insured persons suffering from mental illness need long-term hospitalization, from the date of hospitalization for mental illness to the annual deadline of this medical insurance for a settlement period.

Article 16 If the insured who continuously pays the medical insurance premium for serious illness of the urban elderly in the following year is hospitalized across the medical insurance year, the medical expenses in this settlement period shall be calculated separately according to the medical insurance year. Cumulative calculation of medical expenses incurred before 65438+February 3 1 and medical expenses paid in the current year; The medical expenses incurred in the following year 1 and the medical expenses paid in the following year are calculated cumulatively. The maximum payment limit of urban elderly medical insurance fund is calculated in the current year and the following year respectively.

The medical expenses incurred by the insured within a settlement period shall be paid by Qifubiaozhun. If you are hospitalized again or enter the next settlement period in the following year, the Qifubiaozhun will be paid according to the first hospitalization.

Article 17 If the insured fails to pay the medical insurance premium for serious illness of the urban elderly in the following year, and is hospitalized across the medical insurance year, the medical insurance fund for serious illness of the urban elderly will pay the medical expenses before 65438+February 3 1 in that year, and will not pay the medical expenses after 65438+1 October1in the following year.

Eighteenth insured persons in addition to my choice of three designated medical institutions and designated medical institutions in the specialist, Chinese medicine hospital, but also directly to the designated medical institutions in the city of a hospital for medical treatment.

Insured personnel need to change the designated medical institutions, and go through the change procedures from September/KLOC-0 to June 1 65438+1October 30th every year.

Nineteenth insured persons must hold my "Beijing urban elderly serious illness insurance manual" to the selected designated medical institutions for medical treatment. Designated medical institutions shall examine the medical manuals held by the insured.

Twentieth insured persons can not go to the designated medical institutions I selected for medical treatment because of emergency, but can be hospitalized in the nearest designated medical institutions for emergency treatment, and should be transferred back to the designated medical institutions I selected in time after the condition is stable.

Article 21 If the insured person needs to be transferred for treatment in the city due to illness during hospitalization, it shall be proposed by the deputy chief physician of the designated medical institution and approved by the Medical Insurance Office before going through the transfer formalities. Cumulative calculation of medical expenses incurred after transfer and medical expenses incurred before transfer.

Twenty-second insured hospitalization or outpatient treatment of special diseases, medical expenses paid by individuals in advance, the medical expenses incurred by the designated medical institutions. At the time of settlement, according to the regulations, the part paid by the urban elderly serious illness medical insurance fund shall be settled by designated medical institutions and social insurance agencies, and the rest of the medical expenses shall be settled by individuals and designated medical institutions.

Article 23 If the insured is hospitalized due to emergency rescue and dies during observation, the medical expenses for hospitalization or observation within 7 days before death shall be paid by himself or his family in cash, and the relevant certificates and medical expenses documents shall be presented to the social security office where he is registered at the time of settlement.

Article 24 If the insured carries out outpatient treatment for special diseases, he shall go through the examination and approval procedures for special diseases at the social insurance agency where the household registration is located with the diagnosis certificate, and the outpatient medical expenses for special diseases in designated medical institutions for special diseases shall be paid by the urban elderly medical insurance fund according to regulations.

Twenty-fifth medical expenses incurred by the insured in the emergency hospitalization of designated medical institutions at or above the county level in the field that meet the scope of payment of serious illness medical insurance in this Municipality may be reimbursed to the social security office where my household registration is located.

Twenty-sixth insured persons who have lived in different places for more than 1 year shall go through the registration procedures for medical treatment in different places at the social security office where their household registration is located. You can choose two designated medical institutions at or above the county level and 1 designated medical institutions in this city for medical treatment. Medical treatment shall be carried out in accordance with the provisions of the scope of payment of serious illness medical insurance for the elderly in urban areas of this city. The medical expenses incurred shall be reimbursed by the social security department where I live.

Twenty-seventh insured persons have been hospitalized or outpatient treatment for special diseases before the insurance payment, and the medical expenses before the insurance are settled, and the medical expenses after the insurance are paid by the urban elderly medical insurance fund according to the regulations.

Article 28 Urban elderly people who enjoy the minimum living guarantee for urban residents and the subsidy for urban residents' living difficulties can continue to apply to the civil affairs department for medical assistance for the urban poor after enjoying the medical insurance for serious illness of urban elderly people and meeting the conditions for medical assistance for the urban poor.

With reference to the medical assistance measures for the urban poor, early retirees who enjoy medical treatment and old activists who retire from neighborhood committees can continue to enjoy medical treatment according to regulations through the original channels after enjoying the medical insurance treatment for serious illness of the urban elderly.

Twenty-ninth urban elderly medical insurance does not establish a personal account.

Article 30 The urban elderly who meet the insurance requirements before June 365438+February 0, 2007 should go through the insurance procedures before September 30, 2007, pay the medical insurance premium for serious illness in 2008 at one time according to the payment standard, and enjoy the medical insurance treatment for serious illness of the urban elderly from June 365438+February 0, 2007. The period from 65438+2007 10 to 65438+2008 10 to 365438+February 2008 is regarded as a medical insurance year.

Article 31 Those who have gone through retirement formalities in other cities and enjoyed medical insurance benefits for local urban workers and returned to Beijing to obtain non-agricultural household registration in this city, and those who have gone through the formalities of farmers' relocation in accordance with the provisions of this Municipality and are managed by the civil affairs department, are not included in medical insurance coverage, a serious illness of the elderly in this city.

Thirty-second matters not specified in these Measures shall be implemented with reference to the Provisions of Beijing Municipality on Basic Medical Insurance and related measures.

Article 33 These Measures shall come into force as of June 6, 2007.

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