Detailed rules for payment of basic medical insurance for urban and rural residents in 2023

Pay the basic medical insurance for urban and rural residents in 2023.

In 2023, residents' medical insurance payment has begun. Please remember to pay in time before 65438+February 20, 2022!

one

Who will handle the medical insurance payment for urban and rural residents?

All urban and rural residents except those insured by the basic medical insurance for urban workers. Including college students, secondary vocational schools, primary and secondary schools, special education schools, kindergarten children and other minors and newborns.

two

Payment term?

1. The deadline for centralized collection and payment is 65438+February 20, 2022.

2. The enjoyment period of medical insurance payment for urban and rural residents is: 2023 10/-2023/2 1.

3. If the payment is made after June 65438+1 October 1 in 2023, there will be a waiting period of1month, and you cannot enjoy medical insurance benefits.

three

What is the payment standard?

Basic medical insurance for urban and rural residents Ordinary adult residents pay 480 yuan every year (including long-term care insurance in 50 yuan), and ordinary students and children pay 330 yuan every year. (See attached table for specific payment standard)

four

How to pay in 2023?

The tax authorities provide a variety of payment methods for those who have registered for insurance!

1. If the social security card account has been signed to deduct the premium, please ensure that it is fully deposited in the social security card account, and the tax department will deduct the fee before 65438+February 20.

2. wechat payment. The payers who have participated in the medical insurance for urban and rural residents search for "Xinjiang tax social security payment" through WeChat, and complete the payment through WeChat scan code payment.

★ Note: WeChat payment can be paid for myself or for others.

3. Bank payment. Bring your ID card and social security card, go to the card-holding bank, social security agency and tax service office of the tax bureau, and complete the payment through the bank POS machine or agent client. (During epidemic prevention and control, it is recommended that you use online payment.)

4. Tax net payment. You can log in to Xinjiang Tax Electronic Taxation Bureau and Xinjiang Tax Mobile APP, scan the payment with QR code, and pay by scanning the code through WeChat, Alipay, UnionPay or bank mobile phone.

★ Note: Newly insured and out-of-insurance personnel can use the Xinjiang Corps Medical Insurance Service Platform ("Xinjiang Corps Medical Insurance" mobile APP) to complete registration, real-name authentication or out-of-insurance business, or go to the social security hall to handle related business.

five

What is the proportion of hospitalization reimbursement for residents' basic medical insurance?

The hospitalization reimbursement of residents' basic medical insurance is divided into three steps: first, integration (according to the catalogue of drugs, medical treatment and service facilities of the Corps), second, deduction of deductible, and finally reimbursement in proportion.

The maximum annual payment limit of residents' medical insurance fund is 200,000 yuan.

The threshold of residents' medical insurance hospitalization pooling fund is: 200 yuan, a first-class and below medical institution, 400 yuan, a second-class medical institution, and 800 yuan, a third-class medical institution. The insured shall seek medical treatment in designated medical institutions in the same year, and pay the corresponding Qifubiaozhun for each hospitalization according to the above provisions.

Residents' medical insurance enters the overall cost, and the fund payment ratio is 75% for tertiary medical institutions, 85% for secondary medical institutions and 90% for primary medical institutions.

The proportion of hospitalization reimbursement for poor people, low-income people and residents returning to poverty in secondary and tertiary medical institutions increased by 5 percentage points on the above basis.

six

What is the treatment standard for residents with serious illness in basic medical insurance?

The high medical expenses incurred by insured residents suffering from serious illness shall be guaranteed by serious illness insurance after being paid by residents' basic medical insurance according to regulations. The threshold of residents' serious illness insurance is 15000 yuan. The medical expenses above the deductible line of residents' serious illness insurance shall be paid in proportion by stages. The specific criteria are as follows: the contribution rate of 0-65438+ 10,000 yuan (including 65438+ 10,000 yuan) is 60%, the contribution rate of 10000-200000 yuan (including 200000 yuan) is 70%, and the contribution rate of 200000-300000 yuan (including 300000 yuan)

The minimum threshold for serious illness of poor people, low-income people and returning poor residents is 7500 yuan, and the medical expenses above the minimum threshold are paid in proportion, with the proportion of 0-65438+ 10,000 yuan (including 65438+ 10,000 yuan) being 65%, and the proportion of1000-200,000 yuan (including 200,000 yuan) being 75%.

seven

How to reimburse medical expenses for newborns participating in residents' medical insurance?

Newborns who have completed the payment of basic medical insurance for urban and rural residents in the Corps within 3 months from the date of birth can enjoy the basic medical insurance benefits for residents from the date of birth to the month of payment. If the insured newborn has New Year's Eve within 3 months from the date of insurance to the date of birth, it is necessary to pay the basic medical insurance premium for urban and rural residents for two years at the same time.

If a newborn completes the payment of basic medical insurance for urban and rural residents in Corps within 3 months from the date of birth to one year old, the starting time for its enjoyment is the month of payment.

eight

What are the relevant regulations for residents to seek medical treatment in different places?

(1) If insured residents want to live in different places, they need to bring their household registration or work certificate to the social security branch to fill in the registration form of medical treatment in different places of the Corps or the registration form of medical treatment in different provinces of the Corps, or go through the medical insurance service platform APP line of Xinjiang Corps to go through the formalities of medical treatment in different places. The time limit for the insured to seek medical treatment in different places is 6 months, which shall not be changed within 6 months.

(2) The insured of the Corps shall go through medical treatment in different places for the record, and the outpatient, chronic, special diseases and hospitalization expenses incurred during the temporary return to the overall planning area shall be settled online according to the payment ratio of medical institutions at the same level in the overall planning area.

(3) From September 7th, 20021year, the medical expenses incurred by the insured in other co-ordination areas due to emergency treatment and rescue in the Corps can be temporarily applied for emergency treatment and rescue based on the medical records (including chief complaint, current medical history, diagnosis and treatment) and hospitalization certificates issued by medical institutions before discharge, and can be directly settled and reimbursed online.

(4) If the insured person really needs to be transferred to a medical institution other than the Eighth Division for overall planning due to illness, the First Affiliated Hospital of Shihezi University will issue a transfer certificate, and the hospital will directly handle the transfer formalities.

(5) Severe patients who really need regular radiotherapy and chemotherapy in different places need continuous radiotherapy and chemotherapy in the same medical institution within half a year after going through the referral and transfer procedures, and there is no need to go through the referral and transfer procedures again.

nine

What treatment can residents enjoy in outpatient service?

Chronic and serious diseases in outpatient department

Payment limit of annual overall fund for chronic diseases and serious diseases in residents' medical insurance outpatient department (see the table below)

(2) the "two diseases" of residents

The "two diseases" of residents refer to hypertension and diabetes; The annual reimbursement limit for hypertension drugs is 300 yuan/person; The reimbursement limit for purchasing drugs for diabetes is 400 yuan/person, and the reimbursement ratio is 60% (individual prepayment for Class B drugs 10%).

(3) co-ordinate residents' outpatient services

Residents can also enjoy the reimbursement policy of 80 yuan/the whole year for medical expenses incurred in outpatient treatment.

ten

What benefits can I enjoy by participating in the basic medical insurance for residents?

Insured residents with long-term disability due to old age, illness, disability and other reasons may also apply for long-term care insurance benefits.

Before 20 16 years (including 20 16 years), those who have already participated in the medical insurance for residents in the city will enjoy the long-term care insurance benefits in accordance with the regulations in the month after the long-term care insurance is launched. From 20 17, those who participate in long-term care insurance for the first time in this overall planning area will be given a waiting period of 2 years, during which they will not enjoy long-term care insurance benefits. New insured persons who have been insured for more than 2 years in this overall planning area can enjoy long-term care insurance benefits normally. If the medical insurance relationship of the insured person is transferred from other areas to the local area, the long-term care insurance of that year shall be regarded as the new insurance.

Attachment: Details of Financing Standards for Residents' Medical Insurance of Eight Normal Universities in 2023.

The eighth division Shihezi medical insurance bureau address:

The fifth floor of the main building of the Party and Government Service Center in Shihezi Development Zone.

You can take a bus. H 1, H2, local 10, 12, get off at the Party and Government Service Center.

Telephone numbers of organs and departments of the Medical Security Bureau:

_ Office (Policy and Regulation Section) Tel: 105 10:

0993—27074 13

0993—2020020

0993—2069076

0993—206907 1 (organization of personnel, comprehensive business, party building, party style and clean government)

Telephone number of each department of medical insurance center:

_ General Department (Policy and Regulation Department) RoomNo. 105 10:

0993—26 14256

0993—27074 13

0993—26 14235

0993—2069723 (Organization of Personnel, Comprehensive Business, Party Building, Party Style and Clean Government)

_ Long-term care insurance management section. 20428:

0993—26 13 126

0993—26 13 19 1

0993—26 13 170

0993—2069732 (Long-term care insurance, medical insurance collection, transfer and payment period determination)

_ Medical Security Service Branch No.20427:

0993—26 15076

0993—26 1507 1

0993—26 15082

0993—26 15083

0993—26 15093

0993—26 15095 (reimbursement of medical maternity insurance, management of chronic and special diseases in outpatient department, management of designated medical institutions and pharmacies)

_ Medical Price and Bidding Procurement SectionNo. 10508:

0993—26 14240

0993—2069779

0993—26 14238

0993—26 14237 (Unified Procurement of Drugs and Medical Consumables, Medical Assistance)

_ Audit Department Room No.20428:

0993—26 13 157

0993—26 13 10 1

0993—26 13 135

0993—20697 19 (two institutions supervise and report cases)

_ HouseNo。 Fund Finance Department 10509:

0993—26 14292

0993—26 1428 1

0993—26 14236

Shihezi eighth division social security branch telephone:

Xiangyang Social Security Branch: 0993—7568037

Dongcheng Social Security Branch: 0993—2600675

Laojie Social Security Branch: 0993-7568067

Directly under the Social Security Branch: 0993—2069723

Hongshan Social Security Branch: 0993—2600653

Xincheng Social Security Branch: 0993-75680 19

Shihezi Town Social Security Branch: 0993-26006 12

12 1 Social Security Branch: 0993-5216109

133 Social Security Branch: 0993—5790 129

134 Social Security Branch: 0993-5915011.

136 Social Security Branch: 0990—6936527

14 1 social security branch: 0993-5751464

142 Social Security Branch: 0993—5635072

143 social security branch: 0993-5198780

144 Social Security Branch: 0993—5956030

Shi Zongchang (Beiquan Town) Social Security Branch: 0993—2266479

147 Social Security Branch: 0993—5363 189

148 Social Security Branch: 0993—5387054

149 Social Security Branch: 0993—5667347

150 social security branch: 0993-5163129.

152 social security branch: 0993-2814709