How do retired workers in Tieling supplement medical insurance?

The medical insurance policies in different places are not exactly the same. In some places, medical insurance can be supplemented, while in others, you have to consult your local medical insurance bureau for details (1 14 consultation or face-to-face consultation). You can also call 12333 for national unified social security telephone consultation.

The following information was found on the Internet for reference only.

The "Trial Measures" of the basic medical insurance for urban residents in Tieling City have been adopted at the forty-ninth executive meeting of the fifth Tieling Municipal People's Government on May 6, 2008, and are hereby promulgated and shall come into force as of August 6, 2008.

mayor

June 2008 17

The first general rule

Article 1 In order to ensure the basic medical needs of non-employed urban residents and establish a social medical security system covering all urban residents, these measures are formulated in accordance with the Guiding Opinions of the State Council on Launching the Pilot Project of Basic Medical Insurance for Urban Residents and the Opinions of the People's Government of Liaoning Province on Establishing the Basic Medical Insurance System for Urban Residents, combined with the actual situation of our city.

Article 2 The basic medical insurance for urban residents as mentioned in these Measures (hereinafter referred to as residents' medical insurance) refers to the medical insurance system organized and implemented by the government, which combines urban residents' contributions and government subsidies, and implements social overall planning for urban residents' hospitalization and special disease outpatient medical expenses.

Article 3 Residents' medical insurance shall adhere to the following principles: start at a low level, and the financing level and guarantee standard shall be compatible with the affordability of all parties; Focus on ensuring the medical needs of urban residents for serious illness; Give priority to the needy groups with family (individual) contributions as the mainstay and government subsidies as the supplement; Government organization, policy guidance, voluntary insurance, step by step; Fixed income, balance of payments, a slight balance; Overall coordination, the basic policies and management measures between the various medical security systems are linked.

Article 4 These Measures shall apply to non-employed urban residents who are not included in the basic medical insurance system for urban workers within the administrative area of our city. Residents' medical insurance shall implement a unified policy, with counties (cities) and districts as a whole and territorial management. Urban residents registered in Yinzhou District, Tieling Economic Development Zone and Fanhe New Town shall implement the overall urban planning.

Article 5 The administrative department of labor and social security is the competent department of residents' medical insurance, and is responsible for the formulation, organization, implementation and coordination of relevant policies. Medical insurance agencies are specifically responsible for business management and daily management; The financial department is responsible for raising government subsidy funds and arranging various management and handling funds in the budget, establishing fund financial accounts, and supervising and managing the use of funds; The health department is responsible for the supervision of medical services and standardizing the behavior of medical services; The civil affairs department is responsible for the identification of low-income objects and assisting in organizing the insured work; The education department is responsible for organizing all kinds of school students to participate in medical insurance; Disabled Persons' Federation is responsible for the identification of severely disabled persons and assisting in organizing insurance; The public security department is responsible for the household registration of the insured, and provide relevant basic data in time.

Sixth residents medical insurance and medical services to implement fixed-point management. Medical insurance agencies should strengthen the supervision and management of designated medical institutions to ensure the rational use of funds.

Chapter II Insurance Scope and Application Procedures

Article 7 Any of the following persons who are non-agricultural registered permanent residence within the administrative area of our city may participate in residents' medical insurance in accordance with these measures:

(a) full-time students in ordinary colleges and universities, technical schools, vocational high schools, ordinary high schools, junior high schools and primary schools;

(2) Preschool children under 65438 and non-school urban residents+0.8;

(3)/kloc-non-employed urban residents over 0/8 years old (including 18 years old) under 60 years old;

(four) non-urban workers covered by medical insurance, over 60 years old (including 60 years old).

Eighth in different places to enjoy pension or pension benefits, household registration into the city's personnel are not within the scope of these measures.

Ninth residents to the community as the insured unit, unified by the community to the medical insurance agencies to apply for insurance; Students in the school as a unit, unified organization declaration, apply for insurance. Newly recognized low-income residents and severely disabled people shall go through the formalities of changing their insured status in the community or school from the month of recognition.

After being audited by the medical insurance agency, the medical insurance agency in the overall planning area will issue a "medical insurance card", and the insured person will hold the "medical insurance card" to the designated agent bank savings office in the overall planning area for verification and payment.

Tenth residents to participate in medical insurance should provide household registration books, identity cards, low-income objects, severely disabled people need to provide low assurance, disability certificates and other related documents at the same time, to go through the declaration procedures in the community where the household registration is located.

Eleventh residents to participate in medical insurance at the same time, must participate in large supplementary medical insurance for urban residents. Large supplementary medical insurance shall be undertaken by commercial insurance companies entrusted by medical insurance agencies. The individual payment standard is: students pay 20 yuan; Other personnel pay 40 yuan.

Chapter III Fund Raising

Twelfth residents' medical insurance is mainly based on individual contributions, and the government gives appropriate subsidies. Payment and subsidy standards are:

(1) 1.8 preschool children, students and non-school residents under the age of one year each pay 80 yuan, individuals pay 40 yuan, and the government subsidizes 40 yuan. The minimum target, severely disabled individuals pay 20 yuan, and the government subsidizes 60 yuan.

(2) The annual payment standard for non-employed residents aged over 60 18 (including 18) is 280 yuan, individual payment is 240 yuan, and the government subsidizes 40 yuan. Among them, the minimum living allowances and severely disabled people pay 100 yuan, and the government subsidies 180 yuan.

(3) The annual payment standard for elderly residents over 60 years old (including 60 years old) is 280 yuan, with individual payment 180 yuan and government subsidy 100 yuan, of which the minimum living allowance object and the severely disabled individual payment 80 yuan and the government subsidy 200 yuan.

Thirteenth conditional employers can give subsidies to the immediate family members supported by their employees.

Fourteenth urban residents' medical insurance premiums are paid in advance every year, and the medical insurance agencies are responsible for collecting them. The payment period of medical insurance premium for urban residents in the next year is from September 1 day to February 20th.

Fifteenth eligible residents who are included in the employee medical insurance or other government medical insurance methods will no longer enjoy the treatment of residents' medical insurance, and their contributions will not be refunded.

Sixteenth residents after the insurance, go abroad to settle down, household registration migration, death, etc. , its medical insurance relationship will be automatically terminated, and the paid fees will not be refunded.

Seventeenth residents' medical insurance payment standards and government subsidy standards shall be adjusted in a timely manner according to the economic development and social insurance level of our city and the income and expenditure of funds. The labor and social security department and the financial department shall put forward a plan and report it to the municipal government for approval before implementation.

Chapter IV Basic Medical Insurance Benefits

Article 18 For residents' hospitalization and outpatient treatment of special diseases, the national and provincial basic medical insurance for urban workers, the Drug Catalogue, the Medical Treatment Project and the scope of medical service facilities, the drug catalogue for children and the medical treatment project shall be implemented, and the medical expenses incurred shall be paid by the overall fund according to the prescribed proportion.

Article 19 The medical expenses for residents' hospitalization and outpatient service for special diseases shall be borne by individuals below the Qifubiaozhun, and those above the Qifubiaozhun but below the maximum payment limit shall be paid by the medical insurance fund and individual residents in proportion. Qifubiaozhun for the first hospitalization of insured residents is: first-class hospital (including community health service center) 100 yuan, second-class hospital 300 yuan, and third-class hospital 500 yuan. During the year, the threshold for the second and later hospitalization pooling funds will be reduced by 20%.

The maximum payment limit of the overall fund during the year is 30,000 yuan.

Twentieth residents in a year in accordance with the provisions of the hospital and residence of medical expenses, the overall fund payment ratio: 60% of the community health service center, 55% of the first-class hospital, 50% of the second-class hospital, 45% of the third-class hospital.

Medical expenses incurred by severely disabled people (above Grade B) and low-income workers who have no ability to work, no source of income, and their dependents cannot be hospitalized shall be paid 80% by the overall fund, and the medical expenses borne by them shall be solved through social medical assistance.

Twenty-first residents suffering from the following diseases outpatient medical expenses, included in the scope of payment of medical insurance funds, the overall fund to pay 55%. For those who see a doctor many times in a year, they only need to pay Qifubiaozhun once a year.

(-) Chemotherapy and radiotherapy for various malignant tumors;

(2) dialysis treatment of uremia;

(3) Anti-rejection therapy of organ and tissue transplantation

Twenty-second residents who really need to be hospitalized outside the hospital due to illness must be approved by the highest local hospital and reported to the medical insurance agency for the record. Qifubiaozhun of the overall fund: the provincial capital city is 800 yuan; Transfer to Beijing, Tianjin, Shanghai 1500 yuan. Above Qifubiaozhun, 45% is paid by the medical expenses pooling fund below the maximum payment limit.

Twenty-third residents insured for more than 3 years and less than 5 years (including 5 years), the overall fund payment increased by 2%; Continuous payment for more than 6 years (including 6 years), the overall fund payment increased by 5%.

Twenty-fourth residents have medical expenses above the maximum payment limit of medical insurance, which can be solved by large supplementary medical insurance. The maximum payment limit of large supplementary medical insurance is 70 thousand yuan.

Twenty-fifth residents' first hospitalization refers to the process of patients' admission and discharge procedures. Emergency rescue and hospitalization are uninterrupted, which is regarded as a hospitalization. Infectious diseases need to be transferred to a specialized hospital within 5 days of hospitalization, which can be regarded as a hospitalization, and the Qifubiaozhun of the overall fund is determined according to the hospital level. The inter-annual hospitalization process is determined according to the time of hospitalization.

Article 26 The starting time of residents' medical insurance benefits: September 1 day of the year when students pay fees to August 3 1 day of the following year; Other urban residents pay their own premiums from 1 October 1 to February1.

Residents' medical insurance, which was paid before June 65438+ 10 3, 2008, will enjoy medical insurance benefits from the next month; After June 35438+1 October 312008, the waiting period for the establishment of medical insurance benefits is 3 months, and after one year of insurance payment, the waiting period is 6 months.

Twenty-seventh residents who interrupt payment stop enjoying medical insurance benefits, and the medical expenses incurred during the interruption of payment will not be paid. Those who pay again enjoy medical insurance benefits according to re-insurance, and set a waiting period of 6 months for medical insurance benefits.

Twenty-eighth residents in any of the following circumstances, the medical insurance fund does not

(1) being treated in a non-designated medical institution;

(2) Non-sudden diseases such as visiting relatives for vacation and traveling;

(three) receiving treatment abroad or in Hong Kong, Macao and Taiwan;

(4) Self-injury, self-mutilation and suicide (except mental patients);

(five) fighting, fighting, drinking, taking drugs and causing injuries due to crime or violation of social security management;

(six) traffic accidents, accidental injuries, medical accidents and other medical expenses borne by other parties;

(seven) because of beauty, orthopedics, congenital physical defects and other treatment;

(eight) other expenses that are not paid by the state, provincial and municipal basic medical insurance policies for urban residents.

Chapter V Settlement of Medical Expenses

Twenty-ninth residents hospitalization medical expenses in line with the overall fund payment scope, by the designated medical institutions through the medical insurance business application software computer network system real-time upload to the medical insurance agencies. When residents are discharged from hospital to settle medical expenses, the medical expenses below the Qifubiaozhun as a whole and the part paid by individuals shall be settled by individuals with cash and designated medical institutions. The medical expenses that should be paid by the overall fund shall be allocated by the financial special account after being audited by the medical insurance agency.

Thirtieth residents in hospital, the medical expenses paid by himself, after treatment, with the transfer procedures, valid documents and related medical information and medical insurance agencies to settle the hospitalization expenses.

Thirty-first residents hospitalized, confirmed by the designated medical institutions, the end of treatment has not been discharged, since the end of hospitalization, the overall fund will not pay all the expenses incurred.

Thirty-second medical insurance agencies and designated medical institutions to settle medical expenses, first allocate 90% of the scope of the overall fund, and the rest of the LO% is reserved as a medical service quality guarantee. The deposit shall be settled before March 3 1 of the following year according to the year-end assessment results.

Chapter VI Management of Medical Services

Thirty-third residents' medical insurance services are managed by designated medical institutions. When seeking medical treatment in a designated medical institution, you must hold a basic medical insurance certificate for urban residents in Tieling and an ic card for urban residents' medical insurance, otherwise you will not enjoy medical insurance benefits.

Thirty-fourth designated medical institutions for urban workers' basic medical insurance also serve as designated medical institutions for residents' medical insurance.

Thirty-fifth designated medical institutions shall carefully examine the valid certificates of the insured when receiving medical treatment. If found to be forged, fraudulently used, altered, etc., should be detained, and promptly reported to the medical insurance agency for handling.

Thirty-sixth medical insurance agencies should sign the residents' medical insurance service agreement with designated medical institutions, clarify their respective responsibilities, rights and obligations, and strengthen the assessment, supervision and management of the residents' medical insurance service quality.

Article 37 Designated medical institutions for residents' medical insurance shall adhere to the principle of "treatment due to illness, reasonable examination, reasonable treatment and reasonable fees" and establish and improve the internal management system.

Chapter VII Management of Medical Insurance Fund

Article 38 Sources of residents' medical insurance funds:

(a) the basic medical insurance premium paid by the family (individual);

(two) residents' medical insurance subsidy funds invested by governments at all levels;

(3) Interest and value-added income of the medical insurance fund.

Thirty-ninth residents' medical insurance fund into the social insurance fund financial accounts management, independent accounting, earmarking, shall not be misappropriated. Medical insurance agencies should do a good job in fund raising, payment and management, establish and improve the financial accounting system and internal audit system, and accept the supervision of the financial and auditing departments.

Residents' medical insurance fund and interest income are exempt from taxes and fees.

Article 40 Whoever practices fraud, falsely reports, impersonates or maliciously defrauds the medical insurance fund shall be given administrative punishment according to law, and if the case constitutes a crime, criminal responsibility shall be investigated according to law.

Forty-first residents have the right to supervise residents' medical insurance work, inquire about the payment of medical insurance premiums and the enjoyment of medical insurance benefits, and report violations of laws and regulations by designated medical institutions and insured persons. After receiving the report, the labor security supervision department shall promptly investigate and collect evidence and deal with it in accordance with relevant regulations.

Chapter VIII Supplementary Provisions

Forty-second residents due to major epidemics, disasters and emergencies of medical expenses, by the people's government at the same level for urban residents medical insurance agencies to solve.

Forty-third urban residents medical insurance card use, medical management, hospitalization medical expenses settlement, referral, etc., according to the relevant provisions of the basic medical insurance for urban workers.

Forty-fourth approach by the Tieling Municipal Labor and Social Security Bureau is responsible for the interpretation of.

Article 45 These Measures shall come into force as of August 6, 2008.