20 14 medical insurance for urban workers in tangxian county

1, the medical insurance for urban workers shall be coordinated at the municipal level, and the policies, standards and handling procedures of the whole city shall be unified.

2 payment base (adjusted once a year) is the average monthly salary of employees in the previous year. If it is lower than the minimum payment base determined by the province, it shall be paid according to the minimum payment base (the minimum payment base for 20 14 months is 2300 yuan).

3. Payment ratio: the unit pays 7% and the individual pays 2%; Particularly difficult, the application is made by the unit, and the unit pays 7%. Individuals do not pay fees, do not establish personal accounts, and only enjoy hospitalization medical treatment.

4. Large payment standard: each employee 10 yuan per month, and each unit and individual shall bear the 5 yuan; The monthly 5 yuan payable by retirees is deducted from the personal account.

5. Transfer to the personal account of social security card: according to the payment base, the transfer ratio of working personnel under 45 years old (including 45 years old) is 2.4%, and those over 45 years old are 3. 1% (the payment base is provided by the finance and the unit); Retirees are based on personal pensions, and the distribution ratio is 4%. The next month is transferred to the personal account of last month.

6. If the insured person is hospitalized in a designated hospital in the city, it will be settled directly with the social security card, and only the part that the individual should bear will be paid; If you are hospitalized in the provincial settlement platform, you must first go through the registration formalities at the Medical Insurance Office of the County People's Social Security Bureau (specific address: the intersection of Jinhai No.4 Road and Yinhe No.4 Road in the West District, the west side of the administrative building, and the telephone number is 73 15867), and you can directly settle your personal burden online; If you go to a designated hospital outside the province, you must first register with the county medical insurance office. After leaving the hospital, you will submit the materials required for reimbursement to the unit, which will report them to the medical insurance office in a unified way and reimburse them once every quarter.

7, hospitalization:

The deductible line: the first, second and third level hospitals are 200,600 and 700 yuan respectively, and the second hospitalization in the year is reduced 100 yuan.

Top bank: the basic medical insurance for the whole year is 654.38+million, and the large amount of assistance is 400,000, which is 500,000.

The proportion of reimbursement for basic medical care: 90%, 85% and 80% (expenses within the scope of the policy) for first-,second-and third-class hospitals respectively, and the proportion of reimbursement for retirees increased by 5% respectively. Transferred to designated hospitals in other provinces, non-designated public hospitals outside the province and outside the city were 10%, 15% and 25% respectively.

Large reimbursement ratio: 80%, 70%, 60% and 50% of expenses (expenses within the scope of the policy) between 6,543,800 yuan and 200,000 yuan, 200,000 yuan to 300,000 yuan, 300,000 yuan to 400,000 yuan and 500,000 yuan respectively.

Need to be transferred to hospital for treatment, must be reported to the medical insurance agency for approval, without approval to the hospital outside the city will not be reimbursed.

8. Special diseases: 34 diseases of employees and 4 diseases of residents. Organization identification once a year, registered in August and identified in September. Those who are not hospitalized will not be accepted, including those suffering from malignant tumor, leukemia, uremia, organ transplantation, comprehensive treatment after cardiovascular (brain, aorta) diseases, and mental illness after discharge. The insured's medication is limited to the identified diseases, and each dosage is limited to one month. Drugs and checklists issued by private hospitals and clinics will not be reimbursed. If there are complications, you can buy drugs according to the confirmed complications. General diseases cannot exceed 4 drugs, and under special circumstances, after examination and approval, no more than 6 drugs. Review once every two years, if the disease is cured or the disease is not up to standard due to remission, it will be cancelled. Patients have not incurred medical expenses for 6 months, and their qualifications are automatically terminated. Those who are found to be unqualified may not apply again this year; In the process of identification, if there is fraud, its identification is invalid and it is not allowed to re-apply within two years.

9. The minimum payment period for retirees is 30 years for men, 25 years for women and 25 years for retired workers. Continuous service in line with national policies before starting medical insurance is regarded as payment period. If the payment period is insufficient, the payment shall be made according to the minimum period, and the base and proportion of payment shall be handled according to the current provisions on charges.