Payment of medical insurance for urban and rural residents in luoding city

Yunfu City in 2023

Basic medical insurance for urban and rural residents

Payment has already started.

The payment date is September 1.

Deadline is 65438+February 3 1.

350 yuan per person per year.

Yunfu City in 2023

Basic medical insurance for urban and rural residents

The basic medical insurance for urban and rural residents (hereinafter referred to as residents' medical insurance) is a national policy of benefiting the people. The financing method, which is mainly based on government subsidies and supplemented by individual contributions, provides medical security for urban and rural residents in accordance with the principle of consistent payment standards and treatment levels. No one can guarantee that he will never get sick, let alone that his family will never get sick, so the whole family should participate in medical insurance to ensure that every family member has medical security.

There is no threshold for residents to participate in medical insurance, regardless of the physical condition and age of urban and rural residents. The specific objectives are as follows:

(a) the insured object during the centralized payment period

Urban and rural residents registered in this Municipality (including newborns, excluding employees who are insured by medical insurance); Students from all kinds of schools in our city; Persons who have applied for residence permits (including those from Hong Kong, Macao and Taiwan); Spouses and children of urban and rural residents who have not moved into the household registration can pay for insurance by household during the centralized payment period.

(2) The insured object quits midway.

1. Insured persons who suspend payment of employee medical insurance premiums: urban and rural residents can apply for insurance payment within 3 months after suspension of payment, and medical expenses incurred since the payment is received can enjoy medical insurance benefits. When the annual payment of employees' medical insurance is suspended for more than 3 months, the insured can participate in residents' medical insurance by paying midway according to the regulations, and enjoy medical insurance benefits for the medical expenses incurred in the next month.

2. Newly registered personnel who moved into the overall planning area, students who were transferred to the overall planning area halfway, released prisoners, newly released prisoners, disabled drug addicts (local household registration), and retired soldiers: they can participate in residents' medical insurance in the middle of the year according to regulations, and enjoy medical insurance benefits from the next month after payment.

3. Medical assistance object: you are allowed to join the insurance midway, and enjoy medical insurance benefits from the date when the medical insurance system completes registration and identification.

4. Newborns: newborns registered in this city, newborns whose parents are not registered in this city, and newborns whose parents are not registered in this city (both parents have participated in the basic medical insurance in this city before the birth of their newborns) will enjoy the corresponding residents' medical insurance benefits within 6 months after birth. If a newborn spans two years of residents' medical insurance from birth to insurance payment, after paying the medical insurance premium for two years within six months after birth, it will enjoy the corresponding annual medical insurance benefits according to the residents' medical insurance for two years from the date of birth. Newborns who are insured after 6 months of birth will enjoy medical insurance benefits from the next month of payment.

1. standard: in 2023, the payment standard for residents' medical insurance is 350 yuan per person per year.

2. Time: September 2022 1 day-February 3, 20221day is the medical insurance enrollment period for Yunfu residents in 2023. (If you need a refund due to death, repeated payment, participation in employee medical insurance or repeated participation in residents' medical insurance in other co-ordination areas, please apply for a refund before February 3, 20221. If the insured person terminates the residents' medical insurance participation relationship after the beginning of the residents' medical insurance treatment enjoyment period on June 65438+ 10/day, 2023, the individual contribution will not be refunded. )

3. Payment method: Urban and rural residents can directly use electronic payment channels to pay. Urban and rural residents who are newly insured, did not participate in residents' medical insurance in 2022, withdrew from the aid object or did not find the application information, and brought their household registration books, ID cards and other materials to the village (neighborhood) Committee where their household registration is located or the designated acceptance point to go through the insurance payment procedures. Rural residents' insurance payment can be handled by township and village cadres in a unified way. After receiving the cash, the township and village cadres use the electronic payment channel to pay on the spot and confirm the success of the payment.

4. The specific process of electronic payment:

(1) "Guangdong Tax" WeChat official account.

Follow or search for "Guangdong tax" → micro tax → enter the "Guangdong tax pass" applet → login → social security for urban and rural residents → pay social security fees for urban and rural residents → choose Yunfu City, Guangdong Province → choose medical insurance for urban and rural residents → choose payment type → enter household registration information → pay fees.

(2) "Guangdong saves trouble" applet.

Scan the code or search for "Guangdong saves trouble" via WeChat → Login → Taxation → Social Security Services for Urban and Rural Residents → Paying Social Security Fees for Urban and Rural Residents → Selecting Insurance for Urban and Rural Residents → Selecting Payment Type → Paying by myself or on behalf of others → Entering Household Registration Information → Paying.

5. Payment inquiry:

(1) "Guangdong Taxation" WeChat official account payment inquiry

Follow or search for "Guangdong tax" through WeChat code scanning → micro-tax → enter the "Guangdong tax link" applet → login → social security for urban and rural residents → query of social security fees for urban and rural residents → select Yunfu City, Guangdong Province → select the query type "I pay, others pay or enter identity information" → select the insurance type "medical insurance for urban and rural residents" → select the start and end of tax payment period.

(2) Inquire about the payment of "Guangdong Province" applet.

Scan the code or search for "Guangdong saves trouble" on WeChat → Login → Pay taxes → Social security services for urban and rural residents → Inquire about social security expenses for urban and rural residents → Select the inquiry type "I pay or pay for it" → Select the insurance type "Medical insurance for urban and rural residents" → Select the tax payment period from 2023-0/kloc-0 to 2023-65438.

6. Payment voucher issued:

(1) "Guangdong Tax" WeChat official account payment voucher was issued.

If you enter the Guangdong Tax Pass applet through the official account of Guangdong Tax WeChat, you can pay the fee in the following ways: Guangdong Tax → Micro Tax → Entering the Guangdong Tax Pass applet → Login → Urban and rural social security → Issuing an electronic tax bill for urban and rural social security → Tax payment certificate (paper form) → Select "I, others or enter identity information inquiry" as the payment method → Select the beginning and end of the payment period.

(2) The payment voucher of the "Guangdong Province Easy" applet is issued.

Payment through the "Guangdong Provincial Deposit" applet can be handled through the following paths: "Guangdong Provincial Deposit" → login → tax payment → electronic tax receipt → issuing electronic tax receipt for social security for urban and rural residents → tax payment certificate (voucher type) → selecting payment method "myself or others" → selecting 2023-0/-01to 2022.

The medical expenses incurred by the insured in the hospitalization of the designated medical institutions that meet the policy scope shall be reimbursed according to the following provisions, except for Class B drugs (excluding maternity insurance) paid in advance 10%:

Persons who have participated in residents' medical insurance are deemed to have automatically participated in serious illness insurance in the same year, and no additional payment is required. Serious illness insurance and basic medical insurance are settled simultaneously, and the insured person does not need to apply separately. Individuals who meet the requirements of the policy pay by themselves, and the part with an average enrollment of more than 1 10,000 yuan during the year shall be paid according to the following provisions: 60% for those below 50,000 yuan (excluding), 65% for those above 50,000 yuan (including)-6,543.8 million yuan (excluding), and 6,543.8 million yuan (including) during the insurance year.

Appropriately tilt to the difficult groups. Poor dependents (including orphans), patients with severe mental disorders, and severely disabled people (level 1 and level 2) will be paid by the residents' medical insurance fund after the Qifubiaozhun is unified, and 80% of the out-of-pocket expenses of individuals who meet the policy provisions will be paid during the year. After the qifubiaozhun of major illness insurance for the monitoring targets of returning to poverty, urban and rural low-income residents and marginal family members (i.e., the original low-income relief targets) is unified as the treatment paid by residents' medical insurance fund, individuals who meet the policy provisions will pay 70% of the expenses accumulated over 4,500 yuan during the year; There is no annual maximum payment limit for the critical illness insurance of difficult groups.

The medical expenses incurred by the insured in the town health centers (community health service centers), designated village health stations and pilot family doctor services that meet the policy provisions shall be paid at 50%, with no deductible. The maximum payment limit of each insured person is 25 yuan, and the annual cumulative maximum payment limit is 100 yuan.

Insured persons who have gone through resettlement and long-term residence in different places for the record shall meet the medical expenses stipulated in the medical treatment policy at the designated medical institutions at or below the municipal level in the selected 1 record place, and enjoy the reimbursement treatment for general outpatient service according to the standard of the insured place. In the same medical insurance year, you can't enjoy the overall treatment of general outpatient service in this city and the overall treatment of general outpatient service in different places. From June 1 1 to June 65438+2, you can go through the registration formalities of changing the designated point at the medical insurance agency in the insured area and put it on record, and enjoy the overall treatment of general outpatient service from June 1 of the following year.

1, destitute dependents (including orphans): the total hospitalization expenses (including expenses outside the policy) borne by individuals shall be assisted at the rate of 100%, and the cumulative maximum assistance limit during the year is150,000 yuan per person; All medical expenses (including out-of-policy expenses) borne by individuals for outpatient treatment shall be rescued according to the ratio of 100%, and there is no single capping line and annual capping line.

2. Urban and rural minimum living allowances, monitoring targets for preventing poverty return, marginal family members with minimum living allowances (i.e. original minimum living allowances), severely disabled people (level I and II), patients with severe mental disorders, poverty relief targets due to illness and other people with special difficulties as stipulated by the people's government at the county level: 80% of out-of-pocket expenses in the hospitalization policy will be provided, with a maximum assistance limit of 80,000 yuan per person. The cumulative maximum rescue limit is 6.5438+0.5 million yuan. After the rescue, the total medical expenses (including expenses outside the policy) borne by individuals exceed 1000 yuan, and a second rescue is given according to the proportion of 50%, with a maximum of 5,000 yuan for each rescue; The medical expenses for outpatient treatment of specific diseases shall be paid according to 80% of the policy out-of-pocket expenses, and there is no single capping line and annual capping line.

Children aged 0- 14 suffering from leukemia and congenital heart disease are not restricted by the scope of "three catalogues", and there is no deductible for medical expenses. According to the total medical expenses, residents' medical insurance fund pays 70% and medical assistance pays 20%. The application for treatment shall be submitted by the patient's guardian to the county-level medical insurance agency. The designated medical institutions announced by the relevant departments of the province must be selected according to the clinical pathway and diagnosis and treatment norms. In the non-provincial designated institutions for treatment or did not apply for treatment, according to the general hospital settlement.

500,000 yuan per person per year, including 300,000 yuan for basic medical insurance and 200,000 yuan for serious illness insurance.

(1) Real-time online settlement process: if the insured person is hospitalized in a designated medical institution in or outside the city, and the medical institution and medical insurance system in our city have opened online settlement, the insured person will handle online settlement, and the insured person only needs to pay the part, and the medical institution and medical insurance agency will settle the medical insurance payment part.

(II) Materials to be provided for online real-time settlement: When the insured goes to a designated medical institution for medical treatment, hospitalization registration or outpatient settlement of specific diseases, he only needs to show the original of his medical insurance electronic certificate or social security card (ID card and household registration book). If the account has not moved into our city or the person who has not entered the household cannot provide the above information, the original payment invoice shall be provided. Designated medical institutions only need to receive a copy of the above information (excluding ID cards) when handling the registration and settlement of admission. When the information of the insured person is abnormal in the medical insurance system, the designated medical institution must contact the medical insurance agency in the insured place for confirmation in time. Immediate settlement of accidental injury hospitalization also needs to provide Yunfu basic medical insurance accidental injury self-reported commitment letter.

(III) Sporadic reimbursement scope: Sporadic settlement can be made for those who are not settled online for hospitalization in designated medical institutions or for outpatient treatment of specific diseases due to traffic accidents or other accidents.

(4) Information to be provided for sporadic reimbursement: When the insured handles manual (sporadic) reimbursement of medical expenses, he must provide medical insurance electronic certificate or valid identity documents or social security cards [if the social security card is not handled or activated, he must provide a copy of the household registration book and bank passbook (card); If you don't enter the home, you must provide the payment invoice (or medical insurance system to verify the identity of the insured) and a copy of the bank passbook (card), the bill of hospitalization charges, the list of outpatient and emergency expenses (provided by outpatient expenses reimbursement) or the list of hospitalization expenses and diagnosis certificate (provided by hospitalization expenses reimbursement). The reimbursement of children's major diseases must also provide the "Approval Form for the Treatment of Leukemia and Congenital Heart Disease for Children Insured by Medical Insurance for Urban and Rural Residents in Guangdong Province". Accidental injury reimbursement must also provide Yunfu basic medical insurance accidental injury self-reported commitment. For the first time, you must also provide a diagnosis certificate issued by a designated medical institution at or above the second level.

(5) Time limit for sporadic reimbursement: reimbursement of all medical expenses, including hospitalization, delivery in hospital, outpatient specific diseases, major diseases of children, etc. , must be submitted to the township medical insurance agency for reimbursement before March 3 1 of the following year, and will not be processed after the deadline.

The local basic medical insurance designated medical institutions outside the city are all designated medical institutions for residents' medical insurance in our city. Matters not listed in this information shall be subject to the provisions of the document and the new national, provincial and municipal regulations shall prevail.

Consultation telephone number:

Yuncheng district 8399822

Yun 'an District 8633995

Luoding city 3898529

Xinxing county 29772 1 1

Yu 'nan County 8498263