Medical insurance for primary and middle school students in Harbin

Detailed explanation of the basic medical insurance policy for urban residents

1. Who can apply for basic medical insurance for urban residents?

Not included in the basic medical insurance for urban workers in the city's urban household registration personnel (excluding college students), including:

(1) Non-employed residents (hereinafter referred to as "adult residents") aged 18 (inclusive);

(2)/kloc-urban residents under the age of 0/8, including infants (excluding newborns born within 28 days), preschool children and primary and secondary school students (including students studying in secondary specialized schools, technical schools, secondary vocational and technical schools and special schools) (hereinafter referred to as "students and children");

(three) people who have participated in the basic medical insurance for urban workers and terminated their labor relations with the enterprise, and have not continued the medical insurance relationship;

(4) Residents who have participated in medical insurance from July 2006 to February 29, 2006 according to the provisions of documentNo. [2006] 107 issued by Harlow Society.

2. Where should residents apply for insurance?

(a) residents who meet the conditions of insurance can go directly to the community labor and social security workstation where the household registration is located to go through the insurance registration procedures.

(2) Those who have participated in the basic medical insurance for urban workers from July 2006 to February 29, 2006 and terminated their labor relationship with the enterprise, those who have not renewed their medical insurance relationship, and residents who have participated in medical insurance according to the provisions of Haro Shefa [2006] 107, shall go through the registration formalities at the handling place of the basic medical insurance for urban residents in the Municipal Medical Insurance Management Center (No.8-7 Shanghai Street, Daoli District).

(3) Students in school and children in nurseries and kindergartens shall go through the registration formalities at the basic medical insurance agency for urban residents of the Municipal Medical Insurance Management Center (No.8-7 Shanghai Street, Daoli District).

3. How do adult residents, non-school students, children and infants register?

Go to the community labor and social security workstation in the district where my household registration is located to receive and fill out the Application Form for Basic Medical Insurance for Urban Residents in Harbin (hereinafter referred to as the Application Form for Insurance), which belongs to the residents with difficulties stipulated by the state and must be examined and confirmed by the relevant departments. The staff of the community labor and social security workstation inputs personal information for the insured residents according to the application form and related materials provided by them, prints the Notice of Payment for Checking the Information of the Insured Residents in Harbin (hereinafter referred to as the Notice of Payment), and completes the insurance registration procedures after I confirm that it is correct.

Four, has participated in the basic medical insurance for urban workers and terminated the labor relationship with the enterprise, did not apply for the continuation of the medical insurance relationship, how to apply for registration?

During the payment period, the applicant should receive and fill in the Application Form for Basic Medical Insurance for Urban Residents at the Municipal Medical Insurance Management Center (No.8-7 Shanghai Street, Daoli District). For residents with difficulties as stipulated by the state, it must be examined and confirmed by the relevant departments. According to the application form and related materials, the staff of the Municipal Medical Insurance Management Center will enter personal information for the insured residents, print the payment notice, and complete the insurance registration procedures after I confirm it is correct.

Verb (abbreviation of verb) How do residents who have participated in medical insurance according to the document (Haro Shefa [2006] 107) apply for insurance registration?

Before June 30, 2007, 1 1 received and filled in the Application Form for Participating in the Basic Medical Insurance for Urban Residents at the Municipal Medical Insurance Management Center (No.8-7 Shanghai Street, Daoli District), which belongs to the needy residents stipulated by the state and must be examined and confirmed by the relevant departments. City medical insurance management center staff according to the application form and related materials provided by the insured residents for their surrender, refund and insurance procedures.

6. How do schools or kindergartens register students and children?

(1) Schools and kindergartens shall, within the specified time, collect and input the information of students and children at the basic medical insurance handling place for urban residents of the Municipal Medical Insurance Management Center (No.8-7 Shanghai Street, Daoli District), and input the basic information of the unit and students and children as required. The agent of the unit carries the U disk storing the reported data, the application form for insurance, two recent one-inch color photos without a hat, and related materials of low-income families or severely disabled students and children to the municipal medical insurance management center for basic medical care for urban residents.

(2) Schools and child care institutions shall re-submit the basic information of all students or children within the specified time every year to verify the amount of medical insurance premiums collected and remitted by schools or child care institutions this school year.

7. What documents do I need to carry for insurance registration?

When urban residents go through the insurance registration procedures, they need to hold their household registration book, the original and photocopy of their ID cards, and two recent one-inch bareheaded color photos. Belong to the minimum living standard, low-income families over 60 years of age or severely disabled residents, but also need to identify themselves in the civil affairs or municipal disabled persons' Federation departments, and provide the recognized application form for insurance, the Harbin minimum living guarantee certificate for urban residents, the low-income certificate or the People's Republic of China (PRC) (People's Republic of China (PRC)) disabled card (the above materials need to be verified online). Residents insured according to document number. The [2006] 107 issued by Harlow Society also needs to bring the original medical insurance certificate and payment receipt.

Eight, insured residents how to apply for the "Harbin urban residents basic medical insurance certificate"?

Insured residents shall, within ten working days after confirming the insurance payment, hold the payment notice and bank payment receipt to the handling outlets for insurance registration to receive the "Harbin Urban Residents' Basic Medical Insurance Certificate" and the receipt of the certificate-making fee; School students and kindergarten children are collected in schools and kindergartens.

Nine, how to pay the insured residents?

Medical insurance premiums for urban residents are collected annually. After the residents go through the insurance registration formalities, they shall pay the medical insurance premiums payable in the current period at the business outlets of China Agricultural Bank within the prescribed payment period with the payment notice. Medical insurance premiums for students and kindergarten children are collected by schools and kindergartens.

10. What are the time limits for urban residents to pay fees and enjoy medical insurance benefits?

The basic medical insurance premium for urban residents is paid in advance every year, and the payment period of the basic medical insurance premium for urban residents in the next year is from September 1 to February 20, 2007 1 1 to February 20 (note: the payment period for participation is from June 1 1 to June/kloc-0) Adult residents who have gone through the insurance formalities and paid the basic medical insurance premium in full will enjoy the basic medical insurance benefits from next year 1 day. Students and children pay medical insurance premiums according to the academic year, and enjoy basic medical insurance benefits from the next month of payment.

Eleven, which residents belong to the difficult residents stipulated by the state, can enjoy government subsidies?

Mainly low-income objects, elderly people over 60 years old from low-income families, severely disabled people, students and children from low-income families and severely disabled students and children.

Twelve, "adult residents" payment standard?

"Adult residents" financing standard for each person to pay 290 yuan every year.

Thirteen, "students and children" payment standard?

The subsidy standard for "students and children" is 50 yuan per person per year.

Fourteen, after the interruption of payment, how to apply for renewal?

Insured residents who interrupt payment within three months, carrying the original household registration book and medical insurance certificate, belong to the special subsidy object of the government, and are examined and confirmed by the relevant departments, and go through the renewal procedures at the community labor and social security workstation in the area where the household registration is located before March 20 each year, and receive the Notice of Payment for Renewal to pay the owed medical insurance premium at the business outlets of the Agricultural Bank. Enjoy medical insurance benefits after paying arrears for two months; If the payment is interrupted for more than three months, the insurance registration will be re-applied in the next year's insurance payment period. The medical expenses incurred during the interruption of payment shall not be paid by the medical insurance pooling fund.

Fifteen, after the termination of the medical insurance relationship for urban residents, how to deal with the original payment?

Insured urban residents go abroad to settle down, join the army, enter higher schools (universities), move out of their registered permanent residence, and die. The insurance relationship will automatically terminate and the paid fees will not be refunded.

Sixteen, urban residents withdraw from the residents' medical insurance, to participate in the basic medical insurance for urban workers or other forms of government medical security, how to deal with the original payment?

After the urban residents are insured, they will be transferred to the basic medical insurance for urban employees or other forms of government medical insurance according to the regulations, and they will no longer enjoy the basic medical insurance for urban residents, and the fees paid will not be refunded.

Seventeen, residents who have participated in medical insurance according to the provisions of Harrow Social Development [2006] 107 document are changed to participate in the basic medical insurance for urban residents. How to deal with the original payment?

Insured residents should go through the formalities of surrender and refund before June 30, 2007 165438+ to the handling place of basic medical insurance for urban residents in the municipal medical insurance management center (No.8-7 Shanghai Street, Daoli District). If the original medical insurance premium has not incurred medical expenses, the medical insurance premium paid by it shall be refunded; If the medical expenses incurred are lower than the medical insurance premiums paid, the remaining medical insurance premiums shall be refunded.

Eighteen, people who have participated in the basic medical insurance for urban workers and terminated their labor relations with enterprises, and those who have not handled the medical insurance relationship, such as participating in the basic medical insurance for urban residents, how to deal with the original payment? What are the provisions for the renewal of the basic medical insurance for urban workers when they reach the statutory retirement age?

To participate in the basic medical insurance for urban residents, the original payment will not be refunded. To reach the statutory retirement age to apply for the extension of the basic medical insurance relationship for urban workers, the municipal medical insurance management center shall receive and fill in the Transfer Application Form, and the handling personnel shall handle the transfer insurance form. The insured residents shall pay at the rate of 9.5% or 5% according to the average salary of urban workers in the previous year, and make up the total number of years of medical insurance premiums at one time 15 years. Since the second month of the change, enjoy the corresponding medical insurance benefits for retirees.

Nineteen, how do residents get a card to see a doctor after insurance?

Insured residents must be hospitalized, should hold the Harbin urban residents' basic medical insurance certificate to Harbin urban residents' basic medical insurance designated medical institutions for hospitalization procedures, and pay a certain amount of advance payment in advance. The medical expenses incurred in the designated medical institutions shall be settled according to the relevant provisions, and the Qifubiaozhun and the self-paid part shall be paid in cash; Medical expenses incurred in non-designated medical institutions shall not be paid by the medical insurance pooling fund.

20. What are the special disease clinics for adult residents?

Adult residents' special disease clinics include radiotherapy and chemotherapy for malignant tumors, hemodialysis treatment for severe uremia and anti-rejection treatment after renal transplantation.

Twenty-one, what are the special disease clinics for students and children?

The outpatient department for special diseases of students and children includes radiotherapy and chemotherapy for malignant tumor, hemodialysis treatment for severe uremia and anti-rejection treatment after renal transplantation, hemophilia, aplastic anemia and systemic lupus erythematosus.

Twenty-two, suffering from special diseases need outpatient treatment of insured residents how to handle special outpatient procedures?

Insured residents suffering from special diseases can receive the Examination and Approval Form for Special Diseases Outpatient of Harbin Urban Residents' Basic Medical Insurance in designated medical institutions (hereinafter referred to as the Examination and Approval Form for Special Diseases Outpatient), and the chief physician will fill in the diagnosis and treatment process, put forward the treatment plan, and the hospital medical insurance office will review it. Insured patients go through the examination and approval procedures at the municipal medical insurance management center with the "Examination and Approval Form for Special Disease Outpatient Service" and medical insurance certificate issued by the hospital.

Twenty-three, what are the provisions for the insured residents to handle the referral in the city?

Insured residents need to be referred for treatment because of illness. Should be in a hospital with referral qualifications to receive and fill out the "Harbin urban residents basic medical insurance urban referral application form" (hereinafter referred to as the "urban referral application form"), by the chief physician issued a referral opinion, the hospital medical insurance office audit. Go through the examination and approval formalities at the municipal medical insurance management center with the "Application Form for Urban Referral" and "Medical Insurance Certificate".

Twenty-four, the insured residents into which medical institutions in the city?

First Affiliated Hospital of Harbin Medical University, Second Affiliated Hospital of Harbin Medical University, Third Affiliated Hospital of Harbin Medical University (Heilongjiang Cancer Hospital), Fourth Affiliated Hospital of Harbin Medical University, Heilongjiang Provincial Hospital, First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, and Heilongjiang Provincial Hospital of Traditional Chinese Medicine.

Twenty-five, what are the provisions for insured residents to handle off-site referral?

Insured patients who need to be transferred to different hospitals for medical treatment due to illness should receive and fill out the Application Form for Remote Referral of Basic Medical Insurance for Urban Residents in Harbin (hereinafter referred to as the Application Form for Remote Referral) in hospitals with referral qualifications, and the chief physician will issue referral opinions and the hospital medical insurance office will review them. Insured patients shall go to the municipal labor and social security administrative department for examination and approval with the "Application Form for Remote Referral" and medical insurance certificate issued by the hospital.

Twenty-six, insured residents live in other places for a long time, how to go through the formalities of medical treatment in different places?

Insured residents who have lived in other places for a long time and have reached the age of 60 for men and 55 for women can go through medical treatment procedures in other places. Bring the original and photocopy of the temporary residence permit or property right certificate purchased in my name and the medical insurance certificate to the municipal medical insurance management center to receive and fill out the Application Form for Medical Treatment of Urban Residents in Harbin, and go through the medical treatment procedures in different places.

Twenty-seven, what is a one-time hospitalization, what are the specific provisions?

One-time hospitalization refers to the process of admission and discharge procedures for patients. Emergency rescue and uninterrupted hospitalization are regarded as one-time hospitalization. If the infectious disease needs to be transferred to a specialized hospital within 5 days of hospitalization, it can be regarded as a one-time hospitalization after approval, and the Qifubiaozhun of a higher class hospital will be implemented. If the one-time hospitalization process spans years, the year shall be determined according to the end time of diagnosis and treatment.

Twenty-eight, insured residents hospitalization "Qifubiaozhun" is how to stipulate?

The "Qifubiaozhun" for hospitalization of adult residents is: 720 yuan, a tertiary medical institution; 480 yuan, a secondary medical institution; 240 yuan, a first-class medical institution; 200 yuan, a community medical institution.

The "Qifubiaozhun" for hospitalization of students and children is: 400 yuan, a tertiary medical institution; 300 yuan, a secondary medical institution; 200 yuan, a first-class medical institution; Community health institutions 150 yuan.

For those who have been hospitalized for many times in a natural year, since the second hospitalization, the Qifubiaozhun will be reduced by 10% on the basis of the provisions, and for those who have been hospitalized for many times, the Qifubiaozhun for the second hospitalization will be implemented.

29. What are the provisions on the maximum payment limit?

Insured urban residents in a natural year hospitalization medical expenses pooling fund maximum payment limit of 35 thousand yuan. Among them, adult residents suffering from special diseases, in a natural year, the cumulative maximum limit of hospitalization and special disease outpatient medical expenses pooling fund is 40 thousand yuan; For students and children with special diseases, the cumulative maximum payment limit of medical expenses for hospitalization and special disease outpatient service within one academic year is 60 thousand yuan.

30. What are the benefits of hospitalization for insured residents?

Insured residents are required to show the "Harbin Basic Medical Insurance Certificate for Urban Residents", and the expenses within the "Qifubiaozhun" shall be paid by individuals. "Qifubiaozhun" above and below the maximum payment limit meet the expenses paid by the overall planning fund, and adult residents are treated in tertiary medical institutions, and the overall planning fund pays 50%; In secondary medical institutions, the overall fund pays 55%; In the first-class medical institutions, the overall fund pays 60%; Hospitalization in community medical institutions, the overall fund to pay 65%. 70% of the medical expenses incurred by students and children that meet the payment scope of the medical insurance pooling fund shall be paid by the pooling fund.

Thirty-one, how to settle the medical expenses incurred by insured residents in hospital?

The medical expenses incurred by insured residents who are hospitalized in designated medical institutions with the "Harbin Urban Residents' Basic Medical Insurance Certificate" shall be paid in cash by the individual's Qifubiaozhun and the self-payment ratio; Need to be paid by the overall fund, without personal cash advance, by the municipal medical insurance management center and designated medical institutions in accordance with the provisions of direct settlement.

How to settle the medical expenses of mental patients?

Mental patients are hospitalized in specialized medical institutions, and there is no minimum payment standard. In line with the overall fund to pay the scope of medical expenses, individuals bear 25%.

Thirty-three, insured residents referral, remote medical expenses how to settle?

The medical expenses incurred by the insured residents' referral and medical treatment in different places shall be paid in advance by individuals in cash, and will be reimbursed to the municipal medical insurance management center after the diagnosis and treatment. The proportion of referral personal burden in the city increased by 5%; Qifubiaozhun and the proportion of personal burden for off-site referral will be increased by 20% accordingly.

Thirty-four, what are the provisions of the basic medical insurance for urban residents on medication and medical services?

Insured urban residents hospitalized, the implementation of national and provincial regulations on drug list, diagnosis and treatment projects, service facilities and so on.

Thirty-five, under what circumstances can the medical expenses incurred be reimbursed in the municipal medical insurance management center?

(a) due to emergency, in the city's non designated medical institutions in line with the basic medical insurance for urban residents within the scope of payment of medical expenses (within five working days after admission, the municipal medical insurance management center has notified and registered).

(two) the examination and approval procedures for referral in the city have been handled, and the medical expenses incurred in the referral hospital in the city meet the payment scope of the basic medical insurance fund for urban residents.

(III) The medical expenses incurred by the insured residents during their visit to relatives and travel that meet the payment scope of the urban residents' basic medical insurance fund (within five working days after hospitalization, the medical expenses have been notified to the Municipal Medical Insurance Management Center and registered).

(four) the medical expenses that have gone through the examination and approval procedures for referral in different places and are in line with the payment scope of the basic medical insurance fund for urban residents.

(five) the insured residents who apply for medical treatment in different places, and the medical expenses incurred in the referral and emergency treatment of designated medical institutions and non-designated medical institutions in different places belong to the scope of payment of basic medical insurance for urban residents.

36. What documents do I need to bring for reimbursement?

(1) Materials required for reimbursement of emergency medical expenses (including emergency treatment in different places and emergency treatment in non-designated medical institutions in the city): special medical settlement bills, diagnosis certificates, list of medical expenses stamped with the official seal of the hospital (including specific expense items, quantity and unit price), copies of medical records (first page of medical records, admission records, course records, doctor's orders and discharge summaries), and emergency certificates.

(II) Materials required for reimbursement of referral medical expenses: special medical settlement bill, diagnosis certificate, list of medical expenses stamped with the official seal of the hospital (including specific expense items, quantity and unit price) and copies of medical records (home page of medical records, admission records, course records, doctor's advice, discharge summary), original application form for off-site referral or local referral.

(3) Materials required for reimbursement of medical expenses for medical treatment in different places: special medical settlement bill, diagnosis certificate, list of medical expenses stamped with the official seal of the hospital (including specific expense items, quantity and unit price) and copies of medical records (first page of medical records, admission records, course records, doctor's orders and discharge summary). In addition to the above materials, emergency cases must provide emergency certificates, and those who are transferred to hospitals must provide transfer certificates.

Thirty-seven, what is the designated medical institutions for urban residents?

Designated medical institutions for urban residents refer to medical institutions that have obtained the practice license of medical institutions with the approval of the health administrative department and signed a service agreement with the municipal medical insurance management center to provide medical services for urban residents.

Thirty-eight, the basic information of residents insured is wrong, how to change it?

You can go through the information change procedures with the original household registration book and medical insurance certificate at the community labor security workstation where your household registration is located; Students or children in kindergartens, by the school or kindergarten agents to the original account and medical insurance certificate to the city medical insurance management center for urban residents basic medical insurance handling location (Daoli District Shanghai Road No.8-7) for information change procedures. 、

Thirty-nine, how to report the loss of medical insurance certificate?

Call 12333 to report the loss; With the original ID card and recent one-inch bareheaded color photos, reissue the medical insurance certificate at the handling point of basic medical insurance for urban residents in the Municipal Medical Insurance Management Center (No.8-7, Shanghai Road, Daoli District).

Forty, how to set, query and change the medical insurance card password?

Residents set the medical insurance card password while paying medical insurance premiums in the bank; With the original ID card and medical insurance certificate, go to the Municipal Medical Insurance Management Center (No.423 Youyi Road, Daoli District) and make changes in the designated retail pharmacies of urban basic medical insurance.

Forty-one, which medical expenses pooling funds will not be paid?

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

(two) fighting, drinking, self-mutilation, suicide, drug abuse and other injuries caused by crime or violation of the Law on Public Security Administration Punishment;

(3) Injuries caused by traffic accidents, accidental injuries and medical accidents.

Forty-two, how to deal with individuals who violate the registration policy of medical insurance for urban residents?

Insured residents have one of the following acts, and those who do not meet the conditions will be disqualified; If losses are caused to the medical insurance fund, losses shall be recovered; If a crime is constituted, criminal responsibility shall be investigated according to law.

Those who do not have the conditions to participate in the medical insurance for residents in our city register by providing false materials;

(two) personnel who do not meet the conditions of government subsidies cheat subsidy funds by providing false materials;

(three) other violations of the basic medical insurance registration policy for urban residents.

Forty-three, how to deal with the illegal behavior of the staff of the medical insurance agency?

The staff of medical insurance agencies at all levels shall be diligent and honest, perform their duties and accept supervision. If a staff member commits one of the following acts, the insured may complain to the staff member's department or its superior department, and the relevant department shall conduct criticism and education. If the circumstances are serious, administrative responsibility or criminal responsibility shall be investigated according to law:

(a) failing to incorporate medical insurance premiums into the overall medical insurance account according to regulations;

(2) embezzling or misappropriating the basic medical insurance fund;

(three) in violation of the provisions of the basic medical insurance fund management, resulting in the loss of the fund;

(4) changing the medical insurance benefits without authorization;

(five) favoritism, bribery.

Forty-four, how to deal with violations of insured residents?

Insured residents have one of the following acts, recover the paid medical expenses, and impose a fine of more than 500 yuan 1000 yuan; If the circumstances are serious, criminal responsibility shall be investigated.

(1) Forging or altering prescriptions, expense bills and other vouchers;

(two) to provide proof of medical insurance to others, to seek medical treatment as an impostor.

Forty-five, which medical service violations can be reported?

In order to further strengthen the management of designated medical institutions of basic medical insurance in our city, standardize the medical behavior of insured residents, prevent moral hazard, save and rationally use medical insurance funds, and give play to the positive role of social supervision, designated medical institutions have the following acts, which belong to the scope of reporting:

(a) charges are not clearly marked;

(two) the use of unqualified special prescriptions, documents and accounts;

(3) Being admitted to the hospital as an impostor;

(four) diseases or diseases, drugs and services that do not belong to the scope of diagnosis and treatment projects, drug lists and service facilities and payment standards are included in the payment scope of the medical insurance pooling fund;

(5) Examination, treatment and medication beyond the patient's condition;

(6) prescribing drugs for insured residents in the name of work.

Forty-six, where should I report complaints when I find violations?

(a) any unit or individual may report complaints to the municipal labor security administrative department and the municipal medical insurance management center for acts that meet the scope of reporting complaints.

(2) There is no limit to the form of reporting complaints. Informants can come, write, call and other forms to report, and advocate real-name reporting;

(three) after receiving the report, the municipal labor security administrative department and the municipal medical insurance management center shall promptly organize relevant personnel to check the reported matters and inform the informants of the investigation; And keep it confidential for reporting individuals and units.

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