Shaanxi Newborn Medical Insurance Policy in 2023

Newborn medical insurance is actually residents' medical insurance, only for newborn babies born within 12 months. Baby can apply for BB medical insurance card and enjoy medical insurance reimbursement after successfully entering the household.

Shaanxi neonatal medical insurance policy

At present, the number of people participating in urban workers' medical insurance, residents' medical insurance and new cooperative medical care has reached 654.38+0.25 billion, covering more than 95% of the population. The per capita fund-raising of employees is 2,000 ~ 3,000 yuan (related to the fund-raising level of the average social wage in each overall planning area). Residents' medical insurance and new cooperative medical care have also increased government subsidies and individual contributions this year, and the level of protection enjoyed by all insured people has also been greatly improved.

First, the existing medical insurance varieties and medical-related insurance types.

1, basic medical insurance for urban workers

Xi employees pay 2% of their wages, and the unit pays 7% of their wages; Provincial individuals pay 2%, and financial subsidy units pay 10%. Civil servants pay 6% of supplementary medical insurance, and those at bureau level and enjoying special government stickers pay 2%. Participate in the basic medical insurance for one year. The maximum amount of Xi medical insurance is 50,000 yuan, and the provincial level is 45,000 yuan.

On the basis of the basic medical insurance for urban workers, some units also participated in the large medical expense subsidy insurance (also known as serious illness co-ordination). The maximum reimbursement limit for large medical insurance reimbursement is 400,000 yuan in Xi 'an, and 250,000 yuan can be directly reported to the province.

2. Basic medical insurance for urban residents

Xi 'an residents pay individual fees 180 yuan. This year, the financial subsidy is 207 yuan, raising a total of 387 yuan. Some cities or regions with better economy have higher financing costs, while some cities or regions with poor economic conditions have lower financing costs. Minimum living allowance, severely disabled people and urban residents over 60 years old from low-income families, individuals pay 20 yuan, and financial subsidies are given to 230 yuan; Children pay 30 yuan according to individuals, with a financial subsidy of 207 yuan; The minimum living allowance for severely disabled children is paid 10 yuan, and the financial subsidy is 227 yuan.

3. New rural cooperative medical system

Individual contributions in previous years 10 yuan, central financial subsidies 10 yuan, provincial, city and county subsidies 10 yuan. This year, subsidies from the central government, provinces and cities have been gradually increased to 200 yuan. In 30 yuan, the individual pays, and the maximum reimbursement for hospitalization within one year after enrollment is 50,000 yuan, and each hospitalization is 30% to 70% according to the level and cost of the designated hospital. The reimbursement rate of hospitalization in township hospitals is higher than that in municipal and provincial hospitals. Because of the overall planning of districts and counties, the proportion of reimbursement varies from place to place. After the unified planning of the whole city or the whole province, the differences between regions and counties can be narrowed. This year, the average reimbursement for hospitalization in Shaanxi counties is more than 40%, with a maximum reimbursement of 50,000 yuan/year.

4, retired personnel medical expenses

Retirees refer to veteran cadres who participated in the revolution before the establishment of People's Republic of China (PRC) and workers who participated in the revolution before the establishment of People's Republic of China (PRC). The medical expenses they enjoy are fully reimbursed by the state financial allocation, and individuals do not have to pay any proportion of the expenses. Theoretically, according to the illness, there is no limit to medical expenses. In order to reduce waste and control the total medical expenses of retirees, the government takes Shaanxi Province as an example. In 2007, the provincial financial subsidy for retirees was 5,000 yuan per person and the unit subsidy was 7,000 yuan, which was paid by the unit to the Xi Medical Insurance Center and managed by the Medical Insurance Center. Although individual medical treatment does not pay the minimum deductible and the proportion of self-payment, it should also refer to the national basic medical insurance drug list and the medical service facilities and diagnosis and treatment project list. If it is beyond the scope, it should be paid at its own expense. In 20 10, according to the regulations of Shaanxi province, all retirees who worked before August 0, 945 will be reimbursed, and 85% of retirees who worked after August 0, 945 will be reimbursed, and 15% will be paid by individuals. Since 20 10, Xi' an has raised 20,000 yuan from the financial per capita, and the unit will no longer pay. Provincial enterprises shall be borne by the provincial finance.

5. Work injury insurance

Industrial injury insurance is organized by the government and paid by enterprises and institutions at 0.5%~2% of total wages. It is used to compensate the medical assistance expenses of employees in case of injury accidents during work. The scope of reimbursement of medical expenses is wider than that of basic medical insurance, and drugs are listed in the national basic medical insurance and industrial injury insurance. Individuals don't have to pay any proportion of fees.

6. Maternity insurance

Maternity insurance is a kind of maternity medical insurance organized by the government to protect women's rights and interests. Forced by the government, all employers are required to pay 0.5% of the total wages and compensate employees for medical expenses incurred during childbirth.

7. Medical insurance for college students

All college students will participate in residents' medical insurance.

8. Medical assistance

The civil affairs department gives a certain proportion of assistance to the medical expenses of the poor people in urban and rural areas after illness, and compensates the medical expenses incurred by the poor people without owners in the hospital.

9. Huimin ward

Also known as the Poverty Alleviation Ward, it is a policy of benefiting the people launched by the health administrative department of Shaanxi Province in 2006, aiming at alleviating the problem of poor people's difficulty and expensive medical treatment. It requires hospitals at all levels to reduce or exempt 20% of large-scale examinations, bed fees and medical treatment fees exceeding 100 yuan during outpatient or hospitalization, with valid certificates from local township governments or county civil affairs departments.

10, commercial medical insurance

There are many kinds of medical insurance provided by commercial insurance companies, and the compensation is different. Commercial medical insurance organized by insurance companies is different from social medical insurance organized by the government. Commercial medical insurance is voluntary, and you must have a physical examination when you participate. You can only participate in the physical examination if there is no special disease. Otherwise, you will be insured in reverse, and the insurance company will not recognize it. There will be a 3-6 month observation period after payment. After the observation waiting period expires, you will be compensated according to the contract.

Shaanxi Newborn Medical Insurance Handling Process

How can people enjoy insurance benefits when they participate in medical insurance?

No matter whether you have participated in social medical insurance organized by the government, that is, urban workers' medical insurance, urban residents' medical insurance or new rural cooperative medical insurance, or other commercial medical insurance, work injury insurance and maternity insurance, you must be clear about the types of insurance you participate in and the requirements and regulations for reimbursement when you see a doctor or stay in hospital.

1. Patients who participate in the basic medical insurance for employees in Xi or provinces and municipalities directly under the central government must bring their medical records, ic cards (provincial medical insurance cards) and ID cards before seeing a doctor, and actively identify themselves to the doctor when seeing a doctor. CT, ECT, MRI, cardiac B-ultrasound, TCD, gastroscope, colonoscopy, dynamic electrocardiogram, hyperbaric oxygen chamber treatment, extracorporeal shock wave lithotripsy for urinary or biliary calculi, extracorporeal radiofrequency therapy for severe prostatic hypertrophy, hysteroscopy, outpatient CT, ECT, MRI, cardiac B-ultrasound, TCD, gastroscope, colonoscopy, dynamic electrocardiogram, hyperbaric oxygen chamber treatment, extracorporeal shock wave lithotripsy for urinary or biliary calculi, and extracorporeal shock wave lithotripsy for severe prostatic hypertrophy. General outpatient examination, treatment and medication can be paid by my IC card or cash, and will not be reimbursed. The provincial government and Xi 'an have subsidies for some chronic diseases in the outpatient department, and the unit manager is needed to assist in the examination and approval procedures in the medical insurance center.

2. When the insured person is hospitalized, he should inform the outpatient doctor in advance of the kind of medical insurance he has participated in, and show his medical insurance book and medical insurance card. After the outpatient doctor issues the hospitalization certificate, he will go to the designated hospital medical insurance office for inspection and registration with the hospitalization certificate, medical insurance book, medical insurance card and ID card. The medical insurance in Xi 'an and some cities has restrictions on the catalogue of inpatient diseases, so he can enjoy the medical insurance in the catalogue of diseases and be reimbursed, otherwise he can't be reimbursed for hospitalization.

3. Some city, district and county medical insurance centers also stipulate that when insured patients are hospitalized, they must first submit the hospitalization certificate, diagnosis certificate and medical insurance account books to their medical insurance centers for examination and registration, and the medical insurance centers can issue hospitalization approval forms and transfer them to hospitals before they can be hospitalized. After treatment, the expenses can be reimbursed.

4. Patients with medical insurance in the province or patients with medical insurance in the province take anti-rejection drugs, hemodialysis, peritoneal dialysis, radiotherapy and chemotherapy in the outpatient clinic because of renal failure after organ transplantation. The attending doctor fills out the Examination and Approval Form for Outpatient Special Disease Expenses and the treatment plan in the outpatient clinic, and goes to the city (or province) medical insurance center for examination and approval after being audited and stamped by the hospital medical insurance office. (Some medical insurance centers are simplified, and they no longer go to the medical insurance center for approval) Hemodialysis and taking anti-rejection drugs can be reimbursed according to the ratio of 1:9, that is, the individual pays 10%, and the remaining 90% is settled with the medical insurance center by the outpatient department of the designated hospital on a monthly basis. Outpatient radiotherapy and chemotherapy individuals pay the out-of-pocket proportion of Class B drugs first, and the rest and treatment expenses are reimbursed according to the proportion of 3: 7, that is, 30% of the out-of-pocket expenses, and the remaining 70% is settled by designated hospitals and medical insurance centers.

5, the insured workers outpatient general examination and treatment will not be reimbursed, with medical insurance personal account IC card or cash payment, because the amount of Xi personal account is small, so unless necessary, after the diagnosis is clear, the examination and treatment drugs should be carried out as far as possible after hospitalization.

6. If the diagnosis of emergency patients is clear, try to go through the hospitalization procedures, otherwise it will be more troublesome to reimburse the expenses after the outpatient rescue observation. Outpatient emergency rescue expense reimbursement needs outpatient rescue medical records, expense list, double prescription, emergency certificate, etc. These materials are summarized to the municipal medical insurance center for reimbursement, and 70% of the total expenses are reimbursed after deducting the threshold fee from 850 yuan (provincial 650 yuan). There is a certain amount of reimbursement for different diseases every year.

7. After hospitalization, the proportion borne by individuals and hospitalization Qifubiaozhun will be delivered at the time of discharge, and the rest will be settled by hospitals and medical insurance centers. The out-of-pocket rate of Xi medical insurance inpatients accounts for about 30~35% of the total hospitalization expenses. Reimbursement 65%~70%.

8. During outpatient service or hospitalization, the insured person should remind the doctor from time to time that he is an insured patient, and remind the doctor to choose the examination, treatment and materials as far as possible within the scope of medical insurance, otherwise it will not be reimbursed. If you apply for expensive drugs and materials, the amount of expenses borne by the individual may be very large. When you don't understand, you should consult the unit medical insurance agency, the hospital medical insurance office and the medical insurance center. The medical staff of the self-funded project shall obtain the consent of the insured and sign an agreement beyond medical insurance coverage.

9. Residents' medical insurance

700 yuan lowered the minimum payment standard for tertiary hospitals of Xi residents' medical insurance. In 950 yuan (the first time), which is lower than employees' medical insurance (take 3A hospitals as an example), the accounting of reimbursement ratio is relatively simple, with 55% paid by individuals, 45% reimbursed by children and 5% reimbursed by children. Adults report a maximum of 35,000 yuan per year, and children report a maximum of 40,000 yuan per year. There is no large Medicaid insurance (or serious illness supplementary insurance, serious illness overall planning, etc.). ), its disease list, drug list, service facilities and diagnosis and treatment items are the same as employee medical insurance; There is no disease restriction for children. 50% reimbursement for the overall fund of secondary hospitals and 50% reimbursement for individuals; 60% of the first-class hospital's overall fund is reimbursed, and the individual pays 40%; Community health institutions to co-ordinate the fund to pay 70%, individuals bear 30%. On the basis of the above, the proportion of reimbursement for children will be increased by 5%.

10, retirees should be reimbursed in full in principle, but reference should be made to the employee's medical insurance drug list, service facilities and diagnosis and treatment project management; Drugs, materials, etc. , not within the scope of employee medical insurance, from 20 10, all will be reimbursed to1retirees who joined the work before August 0, 945, and 85% of retirees who joined the work after August 0, 945. Retirees don't need to pay the minimum threshold and personal proportion, and retirees have no disease list restrictions.

1 1, industrial injury insurance

Work-related injury insurance is used for medical insurance and the catalogue of work-related injury drugs, and the inspection and treatment expenses within the scope of employees' medical care and service facilities are fully reimbursed, and individuals do not need to pay part of the expenses. Starting from this year, some towns also use the method of hospital deduction to settle accounts, instead of being paid in full by individuals, and will be reimbursed to the industrial injury insurance center after discharge.

12. Maternity insurance

At present, Xi's maternity insurance adopts a fixed subsidy, with a subsidy of 4,000 yuan for each natural delivery and 6,000 yuan for cesarean section (including prenatal examination) (the reimbursement amount varies from city to city). After the individual and the hospital settle the discharge expenses in full, they will bring the discharge invoices, diagnosis certificates, copies of cases and other materials to the maternity insurance department of the municipal medical insurance center for reimbursement. 26 complications were reimbursed this year.

13, commercial insurance

According to the reimbursement scope of commercial insurance contract, after settling the expenses with the hospital, you should submit the copy of medical records, diagnosis certificate and expense list to the insurance company for reimbursement. It should be noted that the insured of commercial insurance needs to get in touch with the agent when being hospitalized, discharged and reimbursed, so as to provide help.

14, new rural cooperative medical system

The reimbursement deductible line of the new rural cooperative medical system is not uniform in all districts and counties. In 2008, the deductible line of through train subsidy in provincial tertiary hospitals was 5,000 yuan, and after exceeding this line, 40% was reimbursed. The upper limit of subsidy for tertiary hospitals is RMB 0.5 million per household/kloc-0. /kloc-60% subsidy for children under 0/4 who reach 5000 yuan. The same patient should go through the formalities of registration and approval with the joint venture company in Nong Xin in their respective districts and counties before hospitalization, otherwise they will not be reimbursed after discharge. If it is a designated hospital that reimburses the through train, when you leave the hospital, you should go to the new rural cooperative medical system office of the hospital to go through the formalities and pay the individual part. The part that needs reimbursement from the new rural cooperative medical system shall be settled by the designated hospitals and the local county new rural cooperative medical system.

This year, the fund-raising standard has been raised, and the proportion and limit of reimbursement in cities and counties have been raised to 50,000 yuan.