What is supplementary medical insurance for civil servants and Medicaid for civil servants?

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What is supplementary medical insurance for civil servants? Measures of Zhongshan Municipality on Supplementary Medical Insurance for Civil Servants.

Article 1 In order to ensure the medical treatment of civil servants, these measures are formulated in accordance with the Notice of the Ministry of Labor and Social Security and the Ministry of Finance on Forwarding the Implementation Opinions of National Civil Servants' Medicaid (Guo Fa [2000] No.37) and the Interim Measures of Guangdong Province on National Civil Servants' Medicaid (Guangdong Government Office 1999+004) and other relevant provisions, and in combination with the actual situation of this Municipality.

Article 2 The following insured persons who have participated in the basic medical insurance in our city can participate in the supplementary medical insurance for civil servants: (1) Civil servants (including workers) of state administrative organs and their retirees; (two) the staff (including workers and staff) and retirees of party and mass organs, people's congresses, CPPCC, judicial organs, procuratorial organs, democratic parties, federations of industry and commerce and other organs approved to refer to the management of the civil service system; (three) institutions (including workers) and their retirees managed by the civil service system with the approval of the personnel department of the State Council or the provincial people's government; (four) experts who enjoy the special allowance of the State Council in our city; (5) Staffing of other institutions (including retirees).

Article 3 Insured persons who participate in supplementary medical insurance for civil servants will no longer participate in supplementary medical insurance.

Article 4 The supplementary medical insurance premium for civil servants shall be paid on a monthly basis based on the average monthly salary of employees in the whole city in the previous year, according to the following proportions: (1) The employer shall pay according to the payment base 15%, and the individual civil servants shall pay according to the payment base of 3%; (two) personnel and administrative relations in our city to enjoy the special allowance of the State Council experts, individual workers according to the proportion of 3% of the base pay, the municipal finance according to the base pay 15% subsidy; Retirees are subsidized by the municipal finance according to 18% of the payment base; (3) Retirees who participate in supplementary medical insurance for civil servants other than those specified in Item (2) of this article shall be paid by the employing unit according to the payment base 18%.

Article 5 The employing unit is responsible for filling in the Register of Civil Servants' Supplementary Medical Insurance Insured in Zhongshan City, and after reporting it to the municipal human resources and social security department and the financial department for examination and confirmation, it shall go through the insurance registration formalities with the relevant information to the municipal social insurance agency.

Article 6 The municipal human resources and social security department shall examine the qualifications of experts who enjoy the special allowance of the State Council in the personnel administrative relations of our city, fill in the roster of experts and confirm their administrative level. After being audited by the municipal finance department, the municipal social insurance agency shall handle the registration formalities of supplementary medical insurance for civil servants. Every July, the number of experts participating in the supplementary medical insurance for civil servants and the amount payable shall be approved by the municipal social insurance agency, and after being reported to the municipal finance department for examination, the municipal finance department shall allocate the supplementary medical insurance subsidy funds for civil servants to the financial accounts of the supplementary medical insurance fund for civil servants. Persons who have been sentenced, dismissed from public office and settled abroad are not included in the civil service to supplement medical insurance coverage.

Article 7 The employing unit shall go through the insurance declaration formalities with the local tax department before 25th of each month, and pay the civil servants' supplementary medical insurance premium in full. Supplementary medical insurance premiums for civil servants paid by individuals shall be collected and remitted by the employer. The insured units that originally participated in Medicaid for civil servants shall be regarded as participating in supplementary medical insurance for civil servants according to these measures, and paying supplementary medical insurance premiums for civil servants according to the original payment method. Is a self financing unit, such as no longer participate in the supplementary medical insurance for civil servants, should be in the year before May 23rd to the municipal social insurance agencies to handle the relevant formalities.

Article 8 The civil servants' supplementary medical insurance premium paid by the employer and the insured shall be included in the civil servants' supplementary medical insurance fund, which shall be managed by the municipal financial special account and used for special purposes. Article 9 The supplementary medical insurance for civil servants shall be based on the combination of pooling funds and individual medical accounts.

Article 10 The insured who participates in the supplementary medical insurance for civil servants shall establish a personal medical account for them by the municipal social insurance agency, and from the second month of the payment month, the funds shall be transferred to their personal medical account according to the regulations, and the insured may also enjoy the overall outpatient medical treatment and the supplementary medical treatment in hospital according to the regulations. If the insured person stops paying the supplementary medical insurance premiums for civil servants, he will no longer enjoy the supplementary medical insurance benefits for civil servants from the next month 1 day after the payment is stopped, but the balance of his personal medical account can continue to be used.

Article 11 Individual medical accounts and their management. (1) fund transfer. City social insurance agencies according to the insured's age and position (retirees according to their pre-retirement positions) according to the following standards every month to the insured's personal medical account included funds. 1, insured persons under the age of 36 are included in 75 yuan; Those over the age of 36 to under the age of 46 are included in 93 yuan; Over 46 years old included in 1 18.5 yuan; 2. The position of the insured is included in 20 yuan at departmental level, 5 yuan at departmental level 10 yuan. (two) the scope of payment of personal medical accounts. It is used to pay the expenses that the insured person pays for medical treatment in designated medical institutions, or the expenses that the designated retail pharmacies buy medicines that belong to the medical insurance catalogue. (3) Personal medical account management. 1, the balance of individual medical account shall bear interest every year with reference to the deposit rate of resident banks for the same period. The principal and interest of individual medical account belongs to the insured, which can be carried forward to the next social security year for use, transfer and inheritance. 2. The insured person who has settled or worked in a different place for a long time, after going through the relevant formalities, the amount of his personal medical account will be transferred to his personal bank passbook on a monthly basis. 3. Personal medical account transfer method. (1) If the insured person's medical insurance relationship is transferred from other cities to this city, he/she can go through the formalities of personal medical account transfer, and transfer the surplus funds of personal medical account to the personal medical account established by the insured person in this city. (2) If the insured person's medical insurance relationship is transferred from this city to other cities, he/she can go through the formalities for transferring the personal medical account and transfer the balance of the personal medical account to the account designated by the social insurance agency in other cities; If it is really impossible to transfer, the balance of the personal medical account will be returned to me and the social medical insurance relationship will be terminated. 4. When the insured person dies, the balance of his personal medical account shall be paid to the legal heir in one lump sum; If no one inherits, the balance of individual medical account will be transferred to the supplementary medical insurance fund for civil servants.

Twelfth outpatient co-ordinate medical care. 90% of the outpatient medical insurance expenses paid by the insured personally exceed 1000 yuan, and the annual cumulative payment limit is 5000 yuan; For registered special diseases (including two or more special diseases), the annual cumulative payment limit is 10000 yuan.

Thirteenth hospitalization supplementary medical care. After the insured is hospitalized due to illness and enjoys the basic medical insurance benefits (including reimbursement of outpatient medical expenses for specific diseases), the medical insurance expenses paid by individuals in the social security year have accumulated more than 1 000 yuan, 90% of which is paid by the civil servant supplementary medical insurance pooling fund.

Fourteenth civil servants supplementary medical insurance annual cumulative payment limit (including outpatient medical annual cumulative payment limit and inpatient supplementary medical annual cumulative payment limit) is 200 thousand yuan.

Fifteenth insured due to job, level adjustment or job changes, the employer shall, before the 23rd of each month, with the relevant information issued by the Organization Department of the Municipal Party Committee or the municipal human resources and social security department, to the municipal social insurance agency for change procedures. From the month following the change procedure, the funds will be transferred to his personal medical account according to the new job level standard. If the insured person is divorced from the civil service sequence or from the institutions managed by the civil service system, he will no longer enjoy the supplementary medical insurance benefits for civil servants from the next month.

Article 16 Before the implementation of these measures, retirees who have paid the original comprehensive basic medical insurance in one lump sum but paid the original civil servant medical subsidy on a monthly basis shall be paid the civil servant supplementary medical insurance premium in full by the original employer according to the provisions of these measures, and retirees shall enjoy the corresponding medical insurance benefits according to the provisions of these measures.

Seventeenth financial allocation of units, the supplementary medical insurance premiums paid by the financial sector allocated to all units; Self financing units, according to the basic medical insurance payment channels.

Eighteenth civil servants supplementary medical insurance fund payment scope, management and supervision, civil servants supplementary medical insurance payment base, payment ratio and treatment adjustment, rewards and punishments. If there is no provision in these measures, it shall be implemented in accordance with the relevant provisions of the basic medical insurance.

Nineteenth in the social security year, the supplementary medical insurance premium paid by the employer and the insured belongs to the overall fund, and 5% is extracted as the risk reserve of municipal supplementary medical insurance for civil servants. The accumulated balance of municipal civil servants' supplementary medical insurance risk reserve shall not exceed 20% of the income of the current civil servants' supplementary medical insurance pooling fund.

Twentieth after the implementation of these measures, the balance of the original civil servants' Medicaid funds (excluding the funds allocated to individual medical accounts) will be incorporated into the civil servants' supplementary medical insurance fund.

Twenty-first "above" in these Measures includes this number, and "below" does not include this number.

Article 22 These Measures shall come into force on June 1 day, 2065. The Measures of Zhongshan Municipality on Medicaid for National Civil Servants (Zhongfu [2004]141No.) shall be abolished at the same time.

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