Job Recruitment Website - Social security inquiry - Qidong medical insurance when to pay?
Qidong medical insurance when to pay?
1.Basic medical insurance system
2.Employee medical insurance co-ordination scope
3.Resident medical insurance co-ordination scope
3. p> Contribution Standards 1. Employee Medical Insurance Basic Medical Insurance Major Disease Medical Insurance
2. Residents' health insurance
2022 payment standards
The city's universities and colleges (including vocational education) students, individual payment of 330 yuan (including care insurance 30 yuan), the financial subsidy 1140 yuan (including care insurance 40 yuan). Other residents of the city individually pay 530 yuan (including care insurance 30 yuan), financial subsidies 940 yuan (including care insurance 40 yuan).Types of exempted objects
Family members of the minimum subsistence guarantee, special hardship dependents, temporary assistance recipients with serious illnesses, retired workers from the 1960s who are entitled to regular rationed subsistence allowances from the civil affairs department, children in difficult circumstances, family members of workers in special hardship, key beneficiaries of the preferential treatment, the low-income population on file, part of the low-income family, as well as those who are completely exempted from the payment of the insurance premium. Some members of low-income families, as well as persons with severe disabilities (grade 1-2) who are completely or mostly incapacitated for work, elderly party members over 70 years old, elderly people over 90 years old, and patients with severe mental disorders who are prone to accidents and accidents, as determined by the Health Commission, who have a household registration in the city.Time, place and way of payment
1. Employee health insurance
Employer: Monthly payment is declared before the 20th of each month in accordance with the approved payment standard.
Flexible Employees:
1Suspension of insurance status flexible workers in the current year before December 20 to the health insurance window approved in the Alipay, WeChat applet to pay; 2normal enrollment flexible workers in the Payment through Alipay and WeChat applet before December 20 every year. (Those who have signed the bank withholding agreement in the previous period and are normally insured pre-deposit the next year's health insurance premiums from September to November each year.)2. Resident medical insurance
In the city within the urban area of the school students: September 1 - December 20
Remaining residents: November 1-December 20
Payment channels:
●Small yellow machine: Payment is made through self-service payment machines (small yellow machines) in each village (neighborhood) committee. ● WeChat: Payment is made through the "Jiangsu Tax Social Security Payment" WeChat mini program. ● Bank card deduction: you can sign a batch deduction agreement with five banks, including Agricultural Bank of China, Agricultural Bank of China, Bank of Jiangsu, Industrial and Commercial Bank of China, and Construction Bank of China, and make payment by card deduction. ● Bank counter: you can pay through the window of each branch of the five banks: Agricultural Bank of China, Agricultural Bank of China, Bank of Jiangsu, Industrial and Commercial Bank of China, Construction Bank of China.3. Timing
Employee Health Insurance
Flexible Employees:
●First time enrollees will enjoy the corresponding health insurance benefits from the month following the payment procedure; ●Interruption The first time participants enjoy the corresponding medical insurance benefits from the month following the payment procedures; ● Interrupted contributions for less than 3 months and make up the period of interruption of medical insurance premiums in the payment of the account of the next day; ● Interruption of more than 3 months in the payment of contributions in the account of the next month after the enjoyment of the corresponding medical insurance benefits;Medicare Relationship Transfer:
● Qidong to foreign countries: must be within 3 months of the payment of the suspended The transfer of the medical insurance relationship will be carried out within 3 months of the suspension of the payment of fees, and the "participation voucher" will be issued and handed over to the medical insurance agency in the place where the transfer will be carried out for the renewal of the medical insurance participation. The balance of funds in the original individual medical account will be transferred to the new place of participation. ● Transferring back to Qidong from abroad: You have to apply for the renewal of your medical insurance within 3 months of the suspension of contributions with the Participation Voucher and your ID card provided by the medical insurance agency of the place where you are transferring from.Resident's medical insurance
Interruption of contributions:
The two years prior to the interruption of contributions have been paid on time, normal and continuous payment of medical insurance premiums, and due to special circumstances did not pay in the normal period of payment of interruption of contributions, in the stipulated period of payment within three months after the end of the payment of the current year, the payment of medical insurance premiums, from the application for participation in the replacement. If you pay the current year's health insurance premiums within three months after the end of the specified payment period, you will be entitled to the corresponding health insurance benefits from the day following the formalities for making up the premiums; if you fail to enroll in time as stipulated or interrupt the payment of premiums after enrollment, you will be entitled to the health insurance benefits from the month following the formalities for making up the premiums.Newborn babies:
Newborn babies who go through the enrollment procedures within the stipulated period of time (within 6 months of birth) shall pay the resident medical insurance premiums from the month of birth to the end of the year, and shall enjoy the medical insurance benefits from the date of birth.Individual medical account
1.Standardized
Employee medical insurance
Resident medical insurance
Additional medical accounts
Age group
Payment ratio
Below 35 years of age (inclusive) No individual medical account 35 to 45 years of age (inclusive) Weeks of age to retirement Retirees 5%2.
The individual medical account at the beginning of the year according to the contribution base and the transfer ratio one-time pre-planning,at the end of the year according to the actual contribution situation of the unit and the individual will be adjusted.
For example: Wang is 35 years old this year (birthday in October), the contribution base is 5000 yuan, the beginning of this year into the individual medical account 1500 yuan (5000 × × 12), the unit in August will be Wang's contribution base adjusted to 6000 yuan, then early next year will be made up for the four-month difference in the contribution base of 100 yuan (1,000 × × 4) and three-month age difference of 180 yuan (6000 × 1% × 3), the difference in age will be adjusted according to the actual situation of the unit and the individual. 1%×3), and at the same time transferred to the next year's individual medical account 2520 yuan (6000 * individual medical account use rangeThis year's account
Calendar year's balance
Payment of outpatient medical expenses within the scope of medical insurance (including outpatient Class B drugs, Individual out-of-pocket expenses for outpatient Class B drugs, diagnostic and therapeutic items) ● Payment of medical expenses below the hospitalization starting line and above the starting line that are borne by the individual on a pro rata basis ● Individual out-of-pocket expenses for inpatient Class B drugs and diagnostic and therapeutic items ● Medicines and diagnostic and therapeutic items outside of the scope of medical insurance used in outpatient clinics Out-of-scope medicines paid for with the funds of the individual medical accounts' balance in the past years don't include the drugs covered under the Jiangsu Provincial Basic Medical Insurance and Work Injury Insurance and Workplace Health Insurance Programs. Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance Drug Catalog" in the single flavor, the compound is not paid and single flavor of the use of Chinese medicine not to pay for the cost of tablets, medicinal herbs; all kinds of health care, nutrition, tonic, etc.; all kinds of non-pharmaceuticals. The out-of-scope diagnostic and treatment items that can be paid from the balance of the individual medical account in previous years do not include: "Nantong City Basic Medical Insurance Diagnostic and Treatment Items, Scope of Medical Service Facilities and Payment Standards" (Tong People's Social Regulation 〔2012〕 No. 23), which provides for the diagnostic and treatment items of Category C2, C3 and C4, such as ambulance fees, escort fees, television fees, telephone fees, food fees, recreational activities, and some of the special needs service fees. The company's website has been updated with the latest information on the program, including the latest information on the program.Outpatient treatment
1. General outpatient treatment
Participants can choose the nearest designated community health service organization as the contractual unit for their general outpatient treatment. The outpatient (emergency) medical expenses incurred at the designated community health service organization contracted by the participant in accordance with the basic medical insurance regulations will be settled directly by credit card, and the participant will be entitled to the corresponding general outpatient coordinated treatment; if the participant consults the non-contracted medical organization, he/she will not be entitled to the outpatient coordinated treatment.Contracting procedures
Bring your social security card and ID card to the designated community health service organization of your choice, fill out the Service Contract, and go through the contracting and registration procedures.After signing the contract to enjoy the outpatient treatment
Employee health insurance: personal medical account funds (including the personal account funds of the past years) after all the exhaustion of the annual accumulation of more than 600 yuan, the excess of 0 yuan to 4,000 yuan of the part of the social health care fund according to the 70% of the employees, retirees 80% of the proportion of the balance.
Resident's Health Insurance: The Resident's Health Insurance Fund pays 50% of the amount up to the limit of 800 yuan.
2. Outpatient chronic disease treatment
Employee health insurance: the city before December 31, 2010, the original for diabetes, hypertension (II, III) stage, type B active hepatitis B special outpatient patients, the individual medical account funds run out of outpatient special costs annual If the patient suffers from two or more of the above chronic diseases at the same time, the outpatient special expenses will be limited to a total of 4,000 yuan per year. Within the above limit, the social medical fund will pay 50% of the actual expenses incurred, and 70% of the actual expenses incurred will be paid by the social medical fund according to the proportion of in-service and retired people.
This policy has been discontinued in January 2011 to deal with new.
Resident's health insurance: The annual cumulative cost limit for blood pressure or hypoglycemia medicines incurred in outpatient clinics at second-tier hospitals and designated community health service centers is 1,600 yuan; the annual cumulative cost limit for insured patients suffering from both diseases is 2,000 yuan; the annual cumulative cost limit for insured patients suffering from both diseases is 2,000 yuan. The annual cumulative cost limit for insured patients suffering from "two diseases" is 2,000 yuan, and the residents' medical insurance fund will settle 50% of the cost within the limit.
Employee and resident outpatient chronic disease policy and outpatient coordination can not be enjoyed at the same time.
3. Outpatient Special Disease Treatment
Procedures for
(1) Long-term psychiatric treatment for the record by the designated hospitals; (2) Residents "two diseases "The stock of recognized record personnel, can be in the designated township health center (village health center community health service center (station) directly for the stock of recognized record procedures; residents "two diseases" new diagnosis of the record of the insured, can be in the city in line with the provisions of the second level and the second level of the designated medical institutions above the medical insurance office or medical insurance Service station directly for the record procedures; (3) malignant tumors outpatient radiotherapy treatment for the record in designated hospitals. (4) Other diseases treatment case can be in the city with the appropriate qualifications of the hospital health insurance office or health insurance service station for direct processing. (5) Patients with special diseases can go to the window of the medical insurance for outpatient declaration of special diseases with the medical records, discharge summaries and relevant information from hospitals above the second level (including the second level).Hospitalization
Major disease insurance
Self-funded supplemental insurance
The city's workers' medical insurance participants to pay the premiums of self-funded supplemental insurance, you can enjoy the benefits of self-funded supplemental insurance, the participant The part of out-of-pocket medical expenses incurred during hospitalization in a designated medical institution, which were originally borne in full by the individual, will be included in the scope of payment of out-of-pocket supplemental insurance funds. There are more than 700 diagnostic and treatment items and medical service facilities, such as radiofrequency knife, PET, intrathecal target-controlled (program-controlled) drug infusion, as well as more than 300 kinds of medicines, such as hepatocyte growth-promoting hormone, rabies vaccine for human use, and morphine sulphate.1. Participants:
The city's employee health insurance participants2. Contributions:
Self-funded supplemental insurance funds to implement the combination of individual contributions and employee basic medical insurance fund subsidies to raise the method. The financing standard is set at 120 yuan per person per year, of which 60 yuan will be paid by the individual participant and 60 yuan will be subsidized from the balance of the Employees' Basic Medical Insurance Coordination Fund in previous years.3. Contributions:
1. Participating in the united account combined medical insurance personnel, the beginning of each year when the individual medical account pre-planning one-time full deduction. 2. The unretired persons who participate in the hospitalization medical insurance and pay the hospitalization medical insurance premiums by the unit, the unit at the beginning of each year a one-time withholding on behalf of the contribution. 3. Flexibly employed persons who participate in the hospitalization medical insurance shall pay the basic medical insurance premiums for the following year. 4. Retirees participating in the hospitalization medical insurance shall make a one-time contribution at the beginning of each year.4 enjoy the treatment:
Participants in the designated medical institutions during hospitalization, the use of basic medical insurance outside the scope of drugs, diagnostic and therapeutic items within the scope of payment of supplemental insurance at the expense of the social security card by the card settlement, each hospitalization more than 600 yuan part of the funds of the supplemental insurance at their own expense, according to designated supplementary insurance funds, respectively, to determine the level of medical institutions, the payment ratio The payment ratio is determined according to the level of the designated medical institutions, and the payment ratio is 55% for first-level medical institutions, 50% for second-level medical institutions, and 45% for third-level medical institutions, with a maximum payment limit of 100,000 RMB for out-of-pocket supplemental insurance funds within a medical insurance settlement year. Note: In case of transferring to a hospital without a bill, the individual has to pay 10% first and then be reimbursed according to the relevant proportion.#
Hospitalization reimbursement example
Mr. Zhang is a retired person in our city, participating in our city's employees' medical insurance, individual medical account balance of 6,000 yuan, of which the balance of the calendar year is 4,000 yuan, this year for the first time in the people's hospital in Qidong, hospitalized in the hospital medical expenses of 30,000 yuan. The cost of hospitalization is 30,000 yuan. The hospitalization cost of 250 yuan for the basic medical insurance outside the scope of payment of supplementary insurance out of pocket; 1,000 yuan for the basic medical insurance outside the scope of payment of supplementary insurance out of pocket; 2,000 yuan for the basic medical insurance within the scope of the costs should be borne by the individual; 750 yuan for the first hospitalization starting line. The hospitalization costs are calculated as follows: within the scope of the reportable costs: 26000 yuan (30000-250-1000-2000-750); the integrated fund to pay: 24960 yuan (26000 * 96%); major medical insurance to pay: 0 yuan (30000-24960-250-1000 = 3790 yuanPlease note, the following is a list of the most common types of medical equipment.
Mr. Zhang was discharged from the hospital with a cash payment of 1,050 yuan (4840-3790=1,050 yuan).
Different place medical
July 1, 2019 onwards, in the Nantong area designated units can be directly card settlement, do not have to go through the transfer of hospital referral procedures, abolished the original level of hospitals or B level above the provisions.1. The scope of the record
Medical insurance participants to the province, outside of the province, must first apply for the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the record of the social security card or electronic health insurance vouchers to the fixed-point hospitals.2. Scope of settlement of expenses
Medical expenses incurred in hospitals in areas where outpatient and inpatient settlements have been opened.3. The categories of people who need medical treatment in other places and the materials required:
The people who need medical treatment in other places will apply for the registration and filing procedures of medical treatment in other places with their own ID cards, social security cards and relevant materials.1. Retirees resettled in a different place: those who resettled in a different place after retirement and whose household registration was moved to the place of resettlement are required to provide their ID cards.
2. Long-term residents: refers to those who live in a different place and meet the requirements of the place of insurance, and need to provide proof of residence.
3. Resident staff in a foreign country: refers to those who are sent to work in a foreign country by a participating organization and meet the requirements of the participating country, and are required to provide proof of residence.
4. Referral from other places: refers to those who need to be referred to a designated medical institution outside of Nantong due to their medical condition, and are required to provide a referral order from a secondary or higher medical institution in the city. (Note: Residents' medical insurance will first pay 5% of the cost, and then the rest of the cost will be paid according to the medical insurance policy of the place of participation).
5. People who do not have a transfer order: refers to those who need to go to a designated medical institution outside of Nantong City for medical treatment due to personal needs, and need to be applied by the individual. (Note: Employee health insurance individuals first pay 10%, resident health insurance individuals first pay 20%, the rest in accordance with the provisions of the health insurance policy of the insured place to pay).
The following participants need to pay special attention to the filing procedures for outpatient medical treatment in a different place: First, outpatient specific radiotherapy treatment for malignant tumors in a different place should be clearly selected as the outpatient outpatient network of outpatient settlement of the second level and above as a direct settlement of the fixed-point medical institutions. Secondly, for outpatient dialysis treatment of end-stage renal disease in other places, a medical institution with dialysis qualification should be explicitly selected as the designated medical institution for direct settlement of outpatient settlement for outpatient treatment in other places. Third, outpatient organ transplantation anti-rejection, pulmonary hypertension treatment, should be clearly selected as the outpatient outpatient outpatient network settlement of a third-level medical institutions as a direct settlement of the designated medical institutions. Outpatient cataract surgery, please do not use the social security card settlement, by the individual advance payment, in the year to the participating local health insurance agencies in accordance with the policy provisions of the participating places to be reported.6. Warm tips: 1, the insured need to apply for the record of the designated hospitals for special diseases in other places through the health insurance agency of the insured place before the consultation to enjoy the treatment of the relevant special diseases, and the medical expenses incurred in non-selected medical institutions before the record are not entitled to the treatment of the relevant special diseases. 2, due to the differences in catalogs of the localities, the difference in treatment may exist between the direct settlement and the reimbursement of the insured place, which may be different from the treatment of the insured place. Due to differences in catalogs in different places, there may be treatment differences between direct settlement and reimbursement in the insured places, which is a normal phenomenon. According to document No. 3 of Su Renmin Social Affairs Office [2018], if the direct settlement is completed when the insured person is discharged from the designated medical institution across the province, it is not permitted to refund to the insured person due to the difference in treatment.
4. The way to file for medical treatment in a different place
Window for: Qidong City Government Service Center B28-B35 window, townships and cities for the people's service center health insurance window; Fax for: 0513-83117095; Mail for: Qidong City, Huilong Township, Park Road South, No. 199, the government service center. B28-B35 window; Online, palm for:Nantong medical insurance APP (1-3,5 categories of people); National WeChat platform applet; Jiangsu government services website;  - Previous article:Hebi pension insurance inquiry personal account inquiry system
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