Status of Rural Medical Insurance in Zigong City

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Interim Measures of Zigong Municipality on Basic Medical Insurance for Urban Residents

Chapter I General Provisions

Article 1 In order to establish the basic medical insurance system for urban residents and achieve the goal of basically establishing a medical security system covering urban and rural residents, according to the Guiding Opinions of the State Council on Launching the Pilot Project of Basic Medical Insurance for Urban Residents (Guo Fa [2007] No.20) and the Implementation Opinions of Sichuan Provincial People's Government on Launching the Pilot Project of Basic Medical Insurance for Urban Residents (Chuanfuhan [2007]187), combined with the actual situation in Zigong,

Article 2 The basic medical insurance for urban residents shall follow the following principles:

(a) adhere to a low-level start, according to the economic development level of our city, the government and the affordability of urban residents, reasonably determine the level of financing and security standards, and focus on ensuring the medical needs of urban residents for hospitalization and outpatient serious illness;

(two) adhere to the family payment, the government gives appropriate subsidies;

(three) adhere to the principle of voluntariness and implement territorial management;

(four) adhere to overall planning and coordination, and other types of medical security systems that have been established in our city;

(five) adhere to the principle of "fixed expenditure by income, balance of payments, and slight balance";

(six) adhere to the city's unified policy, municipal overall adjustment, and create conditions to gradually transition to the municipal level.

Chapter II Insurance Scope

Third in the administrative area of our city, primary and secondary school students, children and other non-employed urban residents who are not included in the basic medical insurance system for urban workers can participate in the basic medical insurance for urban residents. Specifically including:

(1)/kloc-primary and secondary school students (including vocational high schools, technical secondary schools and technical schools) and non-school children aged 0/8 and above in rural areas (towns);

(2) 18-year-old unemployed urban residents.

Article 4 Migrant workers who have worked in the urban areas of our city for a long time, signed labor contracts with employers and participated in basic medical insurance, and whose accompanying children are under the age of 18 in this city can be insured according to the provisions of these measures.

Chapter III Fund Raising and Transfer

Article 5 The composition of the basic medical insurance fund for urban residents:

(a) the basic medical insurance premium paid by the insured urban residents;

(2) government subsidy funds;

(3) Fund interest income.

Sixth basic medical insurance for urban residents to raise standards:

The payment standard for students and non-school children (including children of migrant workers) below 18 is 1 10 yuan per person per year; For other non-employed urban residents, the payment ratio is about 2% of the disposable income of urban households in the previous year. The specific payment standard is determined and published by the Municipal Labor and Social Security Bureau according to the fund operation in the previous year (300 yuan was implemented in 2008).

Article 7 The objects and standards of government subsidies:

(1) Students in school and children under the age of 18 who are not enrolled in school shall be subsidized to 90 yuan every year. Students from low-income families or severely disabled children will be subsidized on this basis 10 yuan.

(two) 18 years old and above non-employed urban residents each year to subsidize 90 yuan. On this basis, 80 yuan will be given an annual subsidy to the urban minimum living allowance, severely disabled people and low-income families who are over 60 years old (annual subsidy for severely disabled people with urban minimum living allowance 100 yuan).

(three) no ability to work, no source of income, no dependents (dependents, dependents) of the "three noes" personnel by the government full subsidy, individuals do not pay.

(four) people who have two or more identities to enjoy government subsidies at the same time can only enjoy one kind of government subsidies according to the principle of high or low.

Eighth government subsidies for urban residents' basic medical insurance funds by the central, provincial, municipal and district (county) financial subsidies. In addition to the central and provincial financial subsidies, the municipal government subsidizes the insured 20 yuan every year, and the district (county) government undertakes the special population subsidies in its jurisdiction, and the subsidy funds are included in the fiscal budget and allocated in time.

Article 9 Conditional employers can give payment subsidies to the families of employees who participate in the basic medical insurance for urban residents, and enjoy preferential tax treatment in accordance with the relevant provisions of the state.

Tenth the establishment of the basic medical insurance for urban residents as a whole adjustment system, the overall adjustment fund is mainly used for the city's basic medical insurance fund for urban residents when there is a gap in the appropriate adjustment. District (county) finance every year should be according to 5% of the total amount of urban residents' basic medical insurance financing to extract the overall adjustment funds, and one-time turned over to the municipal financial accounts management. Measures for the management and use of the overall adjustment fund shall be formulated separately by the municipal labor and social security department in conjunction with the municipal finance department.

Chapter IV Insurance Payment Methods

Eleventh urban residents' basic medical insurance is paid once a year, and students in school pay the basic medical insurance premium according to the academic year, and the premium paid will not be refunded.

Twelfth students should pay insurance premiums in schools, and children in kindergartens should pay insurance premiums in kindergartens. Other urban residents and non-school children pay insurance premiums with their household registration book to the township (town), street labor security office or community labor security workstation where the household registration is located.

Chapter V Fund Payment Scope and Treatment Level

Article 13 The scope of reimbursement for hospitalization medical expenses of urban residents shall be implemented with reference to the Catalogue of Medicines for Basic Medical Insurance and Work Injury Insurance in Sichuan Province, the Catalogue of Diagnosis and Treatment Projects for Basic Medical Insurance in Sichuan Province, and the Project Scope of Medical Service Facilities for Basic Medical Insurance (Sichuan Labor Society [2000]1/No.). When there are new regulations in the country, province and city, they shall be implemented according to the new regulations.

Article 14 The outpatient medical expenses incurred by urban residents in designated medical institutions due to radiotherapy and chemotherapy of malignant tumors, treatment of chronic leukemia, treatment of systemic lupus erythematosus, dialysis treatment of chronic renal failure and anti-immune rejection drug treatment after liver and kidney organ transplantation shall be regarded as hospitalization medical expenses and included in the payment scope of the basic medical insurance fund for urban residents.

Article 15 The reimbursement of hospitalization medical expenses for urban residents shall be settled in a single hospitalization, and the part above the Qifubiaozhun and below the payment limit within the scope of reimbursement shall be paid in proportion, and the maximum payment limit shall be set for the annual fund payment.

(1) deductible standard: 600 yuan, a first-class medical institution; 500 yuan, a secondary medical institution; 300 yuan, a first-class and below medical institution; There is also 200 yuan, a community health service organization organized by the government.

(2) The reimbursement rate of hospitalization medical expenses above the deductible line: 50% for tertiary medical institutions, 55% for secondary medical institutions, 60% for primary medical institutions, 65% for community health service institutions organized by the government, and 5% for students below 18 and children who are not enrolled in school. Medical staff from other places outside Zigong should pay 10% first, and then be reimbursed according to the proportion of the corresponding hospital.

(3) Maximum payment limit: 20,000 yuan per person per year.

Sixteenth payment period of basic medical insurance benefits for urban residents:

(a) before February 3, 20081day, from the next month of insurance payment, enjoy the medical insurance benefits stipulated in these measures;

(two) from 1, 2009 1, and after 6 months from the date of payment, enjoy the medical insurance benefits stipulated in these measures;

(3) If the follow-up insurance is interrupted for 1 year, after the expiration of 1 year from the date of payment renewal, the medical insurance benefits stipulated in these Measures shall be enjoyed.

Seventeenth people who participate in the basic medical insurance for urban residents should participate in the supplementary medical insurance for urban residents.

Chapter VI Management of Medical Services

Eighteenth basic medical insurance for urban residents medical management services, with reference to the relevant provisions of the basic medical insurance for urban workers.

Designated medical institutions should conscientiously implement the relevant policies and regulations of medical insurance, consciously standardize medical service behavior, and strictly fulfill the medical insurance service agreement.

Nineteenth insured hospitalization expenses in designated medical institutions, which are part of the personal burden, shall be settled by designated medical institutions and individuals; Belonging to the payment part of the basic medical insurance fund for urban residents, the designated medical institutions shall hold relevant information and settle with relevant medical insurance agencies.

Twentieth overall coordination of medical and health, drug production and circulation and medical security system reform system convergence, give full play to the role of basic medical insurance for urban residents in the medical system financing and cost control.

Chapter VII Supervision, Management and Legal Responsibility

Twenty-first urban residents basic medical insurance fund into the financial accounts, the implementation of two lines of revenue and expenditure management, earmarking, separate accounting.

Twenty-second establish and improve the basic medical insurance for urban residents budget and final accounts system, financial accounting system and internal audit system to ensure the safety of the fund.

Twenty-third urban residents basic medical insurance fund payment risks, labor and social security, the financial sector should promptly report to the government, put forward opinions and report to the government for approval.

Article 24 If the insured, designated pharmacies, designated medical institutions and their staff commit fraud and other acts in violation of the provisions of the medical insurance policy, the medical insurance agency shall deal with it in accordance with the relevant provisions of the basic medical insurance for urban workers and the medical insurance service agreement; If the circumstances are serious, the administrative department of labor security shall order rectification within a time limit until the designated qualification is cancelled; If it constitutes a crime, it shall be transferred to judicial organs for handling according to law.

Article 25 If the staff of the administrative department of labor security and the medical insurance agency abuse their powers, engage in malpractices for selfish ends or neglect their duties, resulting in the loss of the basic medical insurance fund for urban residents, the administrative department of labor security shall recover the lost fund; If it constitutes a crime, it shall be transferred to judicial organs for handling according to law.

Chapter VIII Organization and Implementation

Twenty-sixth municipal labor and social security bureau is responsible for the implementation, management and supervision of the basic medical insurance for urban residents in the city, and the municipal medical insurance agency is responsible for the business guidance and specific management of the basic medical insurance for urban residents in the city. District (county) Labor and Social Security Bureau is the competent department of basic medical insurance for urban residents at the same level, and the medical insurance agency is responsible for the business of basic medical insurance for urban residents within its jurisdiction.

The financial department is responsible for the allocation of government subsidy funds and the supervision and management of funds; The audit department is responsible for the audit and supervision of fund income and expenditure; The civil affairs department is responsible for the qualification identification of urban subsistence allowances, low-income families over 60 years old and "three noes" insured persons, assisting in the organization of community residents' insurance and the construction of community labor security platform, and ensuring that the subsidy funds are in place on time and in full; The health department is responsible for guiding designated medical institutions to provide high-quality and preferential medical services for residents; The education department is responsible for urging schools and kindergartens to organize students and children to pay insurance premiums; The Federation of Disabled Persons is responsible for the confirmation of the qualifications of disabled persons; Development and reform, supervision, local tax, price, food and drug supervision and other departments shall, in accordance with their respective responsibilities, assist in the basic medical insurance for urban residents; Sub-district offices and township governments are responsible for the publicity and organization of residents' participation in basic medical insurance in this area.

Twenty-seventh district and county governments should strengthen the management ability and community platform construction of medical insurance agencies. According to the needs of the development of medical insurance, the staff of medical insurance agencies in all districts and counties should be appropriately increased on the basis of the existing establishment. Township and street labor security offices should be equipped with 3-5 full-time staff, and communities should establish labor security workstations with 1-2 staff, of which 1 should be full-time staff, responsible for the basic medical insurance for urban residents. Further clarify the tasks and responsibilities of town, street labor security offices and community labor security workstations in handling the basic medical insurance business for urban residents. Properly solve the funds needed for the construction of medical insurance information system in towns, streets and community service platforms, and the start-up funds and operating funds of medical insurance for urban residents. Start-up funds are arranged according to the number of insured persons (2 yuan/person), and the operating funds are not less than 3% of the raised funds every year, which are included in the fiscal budget by the district and county governments and managed and used by the labor and social security departments in a unified way to ensure the smooth progress of the basic medical insurance for urban residents.

Chapter IX Supplementary Provisions

Twenty-eighth municipal labor and social security bureau is responsible for formulating the detailed rules for the implementation of these measures.

Twenty-ninth approach by the Municipal Labor and Social Security Bureau is responsible for the interpretation of.