Huizhou social security bureau record birth

Basic social medical care is the integration of urban workers, urban residents basic medical insurance and the new rural cooperative medical system, organized and implemented by the municipal people's government, the implementation of a unified system, unified policy, unified management of the basic medical insurance system, including the basic medical insurance for urban workers and the basic medical insurance for residents (hereinafter referred to as the employee medical care and the resident medical care).

(1) Employee medical insurance is a compulsory social insurance of the government. The city's administrative area of the institutions, institutions, social organizations, enterprises, private non-enterprise units, individual business organizations (hereinafter collectively referred to as the employer), should be in accordance with the principle of territorial management for all employees (including retirees) to participate in the employee health insurance. Flexible employment, social application for retirees, as well as Hong Kong, Macao and Taiwan personnel registered for employment in the city, can participate in the employee health insurance

(b) Resident health insurance is a government-organized, individual contributions and financial subsidies to the combination of medical insurance system. Including:

1, in addition to the provisions of the employee health insurance should participate in the city's household registration (including urban and rural household registration, the same below) residents;

2, in the city's various types of institutions of higher education in the city to accept the general higher education of full-time students and graduate students are not on the job.

3. In-service employees of state-owned and collective enterprises that have genuine difficulties in production and operation.

Participants can only participate in one type of basic social medical insurance within the same period of time and enjoy the corresponding medical insurance benefits

What is the contribution standard for employee medical insurance?

Employee medical insurance includes comprehensive basic medical insurance, hospitalization basic medical insurance, supplementary medical insurance and civil servants' medical assistance. Health insurance premiums are paid in accordance with the following provisions:

(1) All employees of organizations, institutions, and social organizations, as well as employees of enterprises aged 30 years or older, employees of privately-run non-enterprise units, and individual industrial and commercial households must participate in the comprehensive basic medical insurance. Their medical insurance premiums are paid by both the employer and the employee***. The employer pays 6.5% of the total wages of the employee participating in the comprehensive basic medical insurance, and the employee pays 2% of his/her average monthly wages. The average monthly salary of employees is less than 60% of the city's average monthly salary of on-the-job employees (hereinafter referred to as the city's last annual social wage), according to the city's last annual social wage of 60% of the levy, the average monthly salary of employees is higher than the city's last annual social wage of 300% of the higher portion of the employee's health insurance premiums will not be levied.

Enterprises, privately-run non-enterprise units and self-employed workers under the age of 30 can choose to participate in the comprehensive basic medical insurance or inpatient basic medical insurance according to the actual situation. For those who participate in the basic hospitalization medical insurance, their medical insurance premiums are paid by the employer at 2% of the city's last year's average social wage, and the individual employee does not pay any premiums.

Flexible workers who choose to participate in the employee health insurance can choose to participate in the comprehensive basic medical insurance or hospitalization basic medical insurance. For those who participate in the comprehensive basic medical insurance, the individual pays 8.5% of the city's previous year's average social wage on a monthly basis; for those who participate in the hospitalization basic medical insurance, the individual pays 2% of the city's previous year's average social wage on a monthly basis.

(2) All participants in the employee health insurance must participate in supplementary medical insurance and pay supplementary medical insurance premiums. Employers (including flexibly employed persons) shall pay monthly contributions of 1% of the city's previous year's average social wage.

What are the rules for retired workers to participate in the employee health insurance?

The employer of a retired employee who participates in the employee health insurance shall choose one of the following contribution methods to pay the employee health insurance premiums for him/her.

(1) Lump-sum payment: The unit shall choose to make a lump-sum payment of 10 years' employee health insurance premiums based on the city's last year's social wage, with an annual increment of 10%, at a contribution rate of 7.5% (including supplementary medical insurance).

(2) Monthly payment: the retiree's own contribution salary as the base (the retiree's own contribution salary is lower than the city's last year's social wage, according to the city's last year's social wage, the same below), by the employer at the rate of 7.5% of the contribution rate (including supplemental medical insurance) to pay each month until the death of the retiree.

(3) Social application for retirees to participate in the employee health insurance, can be provided in accordance with the payment method stipulated in (a) and (b), choose to pay a one-time payment or pay the employee health insurance premiums on a monthly basis.

If an insured employee who has made monthly contributions at the time of retirement needs to change to a one-time lump-sum contribution, his/her post-retirement employee medical insurance contribution period shall be counted as the one-time lump-sum contribution period.

What are the contribution rates for the Resident's Health Insurance?

Residents' health insurance takes the family as the unit of insurance, and members of a household register who are eligible for insurance must be insured at the same time according to the same contribution level, and the following contribution standards can be chosen according to the actual situation of the family: A level: 20 yuan per person per year; B level: 30 yuan per person per year; C level: 120 yuan per person per year;

Those enjoying the minimum subsistence guarantee, rural "Five Guaranteed Households", urban "Three-Nothing Objects" (urban no economic resources, no working ability, no legal alimony or dependents), confirmed by the municipal and county (district) people's government of other special difficulties and various types of first- and second-degree disability residents to participate with the family. Resident C, the individual contribution portion is borne by the financial resources of the county (district) in which they reside.

The central, provincial, municipal and county (district) financial subsidies for residents' health insurance are directly incorporated into the residents' health insurance fund. Among them, the city financial subsidies per person per year 20 yuan, county financial subsidies per person per year 15 yuan.

How to participate in the basic social health insurance?

(a) insured employees (including flexible employment to participate in employee health insurance) by the unit to the business or business registration of the local tax and social security agencies for contributions and registration, and in accordance with the provisions of the monthly to the local tax department to declare the payment of employee health insurance premiums.

(2) The insured residents shall take the family as the unit of insurance, and members eligible for insurance in the same household register must be insured at the same time according to the same contribution level; the residents' medical insurance premiums shall be paid in a natural year.

1, the villagers' committee is responsible for the residents within the jurisdiction for the insurance, should be filled out by the family "Huizhou residents of basic medical insurance registration form", the villagers' committee on behalf of the collection of medical insurance premiums. When residents enroll in the family as a unit, they should provide the social security agency or social security office with a copy of the household register, and fill out the "Huizhou City, residents of basic medical insurance enrollment registration form" for enrollment registration procedures.

2. When people with special difficulties participate in the residents' medical insurance (C grade), they should take the valid documents issued by the civil affairs departments at or above the county level or the disability certificates issued by the Disabled Persons' Federation (limited to people with disabilities of all kinds, Grade 1 and Grade 2) to participate in the residents' medical insurance together with their families.

How do I pay the premiums after enrollment?

(1) Employee health insurance premiums are collected by the local tax authorities; individual contributions are withheld and paid by the employer from the employee's salary on a monthly basis.

(2) Residents' health insurance premiums are collected by social security agencies.

If a villagers' committee is responsible for the collection of the residents' medical insurance premiums, the villagers' committee shall pay the collected premiums to the charging unit designated by the social security agency after going through the registration formalities.

If the residents apply for the insurance premiums on a household basis, the residents shall pay the residents' medical insurance premiums at the fee collection unit designated by the social security agency with the payment vouchers printed by the social security agency or the social security office.

The social security agency or social security office shall issue a certificate of enrollment on a household basis for those residents who are enrolled in the program.

Participants in the residents' health insurance shall pay the health insurance premiums for the following year from September 1 to December 31 each year; if there are any changes in the information, they shall pay the premiums after going through the procedures of changing the information.

Newly enrolled residents in the current year shall pay the current year's health insurance premiums.

How can I pay the premiums if I was originally enrolled in the basic medical insurance for urban residents?

Originally enrolled in the urban residents' medical insurance, from July 1, 2009 to September 30, according to the contribution level selected by me, a one-time payment of residents' medical insurance premiums from July 1, 2009 to December 31, 2010 (i.e., one and a half years of medical insurance premiums: 30 yuan for level A, 45 yuan for level B, and 180 yuan for level C). From 2011 onwards, the resident health insurance premiums will be paid again on a natural year basis (20 yuan for Tranche A, 30 yuan for Tranche B, and 120 yuan for Tranche C).

When will participants start enjoying the health insurance benefits after paying the premiums?

Participating employees and residents who have made contributions during the current year will be entitled to health insurance benefits in accordance with the regulations from the month following the month in which they made contributions.

Participating residents who pay the next year's health insurance premiums within the stipulated payment period will be entitled to health insurance benefits from January 1 of the next year in accordance with the provisions of the Scheme.

Participants shall cease to enjoy health insurance benefits from the month following the month in which they fail to pay their health insurance premiums.

What are the rules for changing information after enrollment?

If a participant has any of the following circumstances, he or she should go to the local tax department, social security agency or social security office in the place where he or she is enrolled to apply for the change procedures in a timely manner:

(1) If a person who is enrolled in the employees' medical insurance has terminated or discharged his or her labor relationship with the employer, the employer should go to the local tax department and the social security agency to apply for procedures relating to the termination of the employee's medical insurance relationship within 20 working days after the employee applies for the discharging of his or her labor relationship. medical insurance relationship related procedures.

(2) If a resident participating in the residents' medical insurance joins the employees' medical insurance after realizing employment or joins the employees' medical insurance as a flexibly employed person, he or she should go to the social security agency or social security office in the place where he or she participates in the insurance to go through the procedures of terminating the residents' medical insurance before applying for the employees' medical insurance, and the residents' medical insurance premiums he or she has paid will not be refunded.

(3) If a person enlists in the army after participating in the employee medical insurance or the residents' medical insurance, the employer or family members shall, within 20 working days, go to the local tax department and the social security agency (or social security office) in the place where the household registration is located to handle the suspension of the insurance by presenting the Notice of Enlistment issued by the conscription office of the local government. The time of new renewal (enrollment) of insurance for discharged retired military personnel shall be calculated from the time when they are approved to leave active service. If a discharged retired military personnel applies for renewal (enrollment) of premium payment within 3 months after approval to leave active service, his active service time is regarded as the time of continuous payment of employee health insurance or resident health insurance. If the renewal (enrollment) is done more than 3 months later, it is considered as a new enrollment, and the service time is not counted as the continuous contribution time.

(4) If a family participating in the residents' medical insurance needs to change its contribution bracket, it should go to the local villagers' committee, social security office or social security agency from September to December to apply for a change in its contribution information for the next year.

How do I choose a general outpatient medical institution?

Participants are required to select a township health center (including administrative village health station) or community health service center (collectively referred to as primary health service institutions) according to the principle of proximity from July to September 2009, and insured employees can select a designated hospital as their first outpatient medical institution (hereinafter referred to as outpatient designated institutions), and from October 1, 2009 onwards, they will be entitled to outpatient treatment in accordance with the regulations. After a participant selects an outpatient fixed-point institution, the employer or individual will register at the social security agency or social security office; or he or she can register at the selected fixed-point institution and fill in the "Huizhou Outpatient Basic Medical Insurance Registration Form".

How is the medical insurance treatment?

(I) Outpatient Treatment

1. For those who are enrolled in Class A of the residents' medical insurance, the payment standard of the medical insurance fund is as follows: the cumulative payment limit per person per year is 200 yuan; the payment ratio for a single outpatient visit is 35%; the payment ratio for the outpatient visit to other fixed-point medical institutions through the outpatient fixed-point institution's referral (including emergency) is 25%; and the payment limit for each visit is 12 yuan.

2. For those who are enrolled in Class B of the Resident Medical Insurance, the payment standard of the Medical Insurance Fund is: the cumulative payment limit per person per year is 300 yuan; the payment ratio of single outpatient expenses is 40%; the payment ratio of outpatient expenses for the outpatient consultation to other designated medical institutions through the outpatient designated institution's referral (including emergency consultation) is 30%; and the payment limit of each payment is 20 yuan.

3. For those who are enrolled in Class C of the residents' medical insurance, the payment standard of the medical insurance fund is: the cumulative payment limit per person per year is 600 yuan; the payment ratio of single outpatient expenses is 50%; the payment ratio of outpatient expenses for the outpatient consultation to other designated medical institutions through the outpatient designated institutions' referrals (including emergencies) is 40%; and the payment limit of each payment is 60 yuan.

4. For those who participate in the employee medical insurance, the payment standard of the medical insurance fund is as follows: the cumulative payment limit per person per year is RMB 800 yuan; for those who seek medical treatment in primary health service organizations, secondary and tertiary hospitals, the proportion of payment of the medical insurance fund for a single outpatient visit shall be 75%, 50%, and 40%, respectively; the proportion of payment shall be reduced by 10 percentage points respectively for those who are referred to other designated medical institutions through the outpatient designated institutions (including emergency treatment).

(2) Hospitalization Treatment

The part of the hospitalization expenses incurred by the insured person due to illness in accordance with the regulations (including childbirth or termination of pregnancy in accordance with the regulations on family planning for those who participate in the residents' medical insurance, hereinafter the same), which are above the starting standard, shall be paid by the medical insurance fund in accordance with the regulations. The starting standard is determined according to the level of hospitals, 100 yuan for first-level hospitals, 300 yuan for second-level hospitals, and 500 yuan for third-level hospitals.

1. After the insured workers have paid contributions for 6 months (excluding 6 months), if they seek medical treatment at a designated medical institution within the administrative area of the city or at a designated medical institution outside the administrative area of the city after transferring to another one, the proportion of basic medical expenses incurred in conformity with the regulations shall be paid by the Employees' Medical Insurance Fund as follows: 90% for active workers and 95% for retired workers. For those who are hospitalized in a designated medical institution outside the administrative area of the city without going through the procedure of transferring to another medical institution, the proportion paid by the fund is 75%. If you go to a non-designated medical institution outside the administrative area of the city for treatment, the fund pays 60%. If the insured employee has paid contributions for less than six consecutive months, the fund pays a uniform 60% of the basic medical expenses incurred for hospitalization. The part of the hospitalized basic medical expenses incurred by the insured employees during the year that exceeds the maximum payment limit of the Employees' Medical Insurance Fund after reimbursement in accordance with the regulations is paid 90% by the Supplementary Medical Insurance Fund, and the individual pays 10% out of his own pocket.

2. When insured residents are hospitalized due to illness and incur in-patient basic medical expenses in accordance with the regulations, the standard of payment by the residents' medical insurance fund is as follows: (1) For those who are enrolled in the A class, 75% for the first-class hospitals, 55% for the second-class hospitals, and 40% for the third-class hospitals. (2) For those participating in class B, 80% for first-class hospitals, 60% for second-class hospitals and 45% for third-class hospitals. (3) For those participating in Tranche C, 85% for Level I hospitals, 75% for Level II hospitals, and 65% for Level III hospitals. (4) For insured residents who have gone through the procedure of transferring to a designated medical institution outside the administrative area of the city for hospitalization and treatment of basic medical expenses in accordance with the regulations, the proportion of payment by the residents' medical insurance fund shall be in accordance with the standards of hospitals of the same level within the administrative area of the city; for those who have not gone through the procedure of transferring to a medical institution outside the administrative area of the city for hospitalization and treatment of basic medical expenses in accordance with the regulations, the proportion of payment by the residents' medical insurance fund shall be reduced by 15 percentage points (or by a different percentage point). will be reduced by 15 percentage points respectively (except for students studying in other places).

(C) Specific Outpatient Clinics

***There are 19 types of illnesses, which enjoy corresponding treatment according to the difference in payment standards.

(IV) Medical insurance assistance

Participants can apply for medical insurance assistance when they are hospitalized due to illness during the year and their personal out-of-pocket expenses (excluding specific outpatient expenses) reach the following standards.

1. If the accumulated personal out-of-pocket expenses of the insured workers reach 5,000 yuan (including 5,000 yuan) or more to 10,000 yuan (including 10,000 yuan) within the year, the payment rate is 40%; if it is more than 10,000 yuan (excluding 10,000 yuan), the payment rate is 50%.

2. If the total out-of-pocket expenses of the insured residents in a year reaches RMB 3,000 (including RMB 3,000) or more to RMB 10,000 (including RMB 10,000), the percentage of payment shall be 40%; if it is more than RMB 10,000 (excluding RMB 10,000), the percentage of payment shall be 50%.

What are the rules for outpatient medical care and how are medical expenses reimbursed?

Participants should seek medical treatment in the selected outpatient institutions, due to the condition of the need to other designated institutions within the administrative region of the city, the outpatient institutions should be in accordance with the provisions of the referral procedures, to present their proof of participation, to be verified after the medical procedures.

I only need to pay the part of the selected outpatient medical institutions, the rest of the medical insurance fund in accordance with the provisions of the payment. After referral (including emergency) to other designated medical institutions within the administrative area of the city outpatient consultation, the medical expenses first by the individual advance payment, the participant should be within 60 days of the date of consultation with the diagnosis of disease certificate, outpatient medical records, valid medical bills, detailed list of medical expenses, outpatient referrals need to provide referral certificates and a copy of the identity card (verify the original) and other information to the outpatient institution of their choice The reimbursement procedure is carried out at the outpatient fixed-point institution of your choice.

What are the rules for hospitalization and how are medical expenses reimbursed?

If a participant seeks medical treatment within the administrative area of the city due to illness, he/she should present his/her certificate of participation and go through the procedures for medical treatment after checking for accuracy. Medical expenses will be settled in the following manner.

(1) If a participant seeks medical treatment at a designated medical institution within the administrative area of the city that is connected to the computer network of the social security agency, he/she only needs to pay for the part paid by himself/herself; the part paid by the medical insurance fund shall be settled directly between the social security agency and the designated medical institution.

(2) In the case of hospitalization (including emergency treatment) in a medical institution within the administrative area of the city that is not computer-networked with a social security agency or outside the administrative area of the city, the medical expenses will be advanced by the individual, and then the individual will be required to pay the medical expenses with the certificate of diagnosis of the disease, the original discharge summary, the original of the valid medical bills, the list of details of the medical expenses, a copy of the bank account number and a copy of the identity card of the person concerned (if the person concerned has no identity card, the household register will be provided), and a copy of the household book will be provided to the hospital. If you don't have an ID card, you can provide your household register; if you are transferred to another hospital, you need to provide transfer procedures; if you are studying in a different place, you need to provide a certificate from your school), etc., and then go to the social security agency or the medical institution entrusted by the social security agency to handle the reimbursement procedures.

(3) If an insured resident is hospitalized in a designated medical institution due to childbirth or termination of pregnancy in accordance with the provisions of family planning, his/her family members should bring along the maternity ID card, marriage certificate, valid family planning certificate, and the "Declaration Form for Maternity Treatment of Basic Medical Insurance for Residents of Hwizou City" signed by the attending doctor to the social security agency or social security office of the place where the insured resident is enrolled to make a declaration, and the hospital will make a declaration on the basis of the "Declaration Form" confirmed by the local social security agency. The hospital will settle the bill according to the regulations with the "Declaration Form of Maternity Treatment of Huizhou Residents' Basic Medical Insurance" confirmed by the local social security agency. If you give birth outside the administrative area of the city, you need to follow the provisions of the second paragraph of this article at the same time.

(4) If a participant is hospitalized within the administrative area of the city due to illness, he/she or his/her family members shall sign and approve the Statement of Hospitalization Expenses of Huizhou Municipal Basic Social Medical Insurance when he/she undergoes the procedures for discharge from the hospital. For disputed medical expenses, the insured person has the right to inquire about the detailed items from the hospital.

Fifteen, what are the provisions for medical treatment in other places?

Students studying in a different place and insured persons living or working in a different place (for more than one consecutive year) should register for medical treatment in a different place.

(1) Those who live and work in a different place need to provide a certificate from the local community neighborhood committee or villagers' committee. Students studying in other places only need to present the acceptance letter of the school they are studying in or other valid certificates (including documents) of the school they are studying in, and go to the social security office or social security office in the place where they are insured to go through the registration procedures.

(2) The insured person shall go to the social security agency or social security office of the insured place to get two copies of the "Registration Form of Huizhou Basic Social Medical Insurance for Residence in Other Places", and choose one or two designated medical institutions for basic medical insurance in the place of residence (if the local basic medical insurance system is not in force in the place, he/she shall choose a public medical institution), and then confirm it after being stamped by the medical institution of the chosen place and the local medical insurance agency (the grade of the medical institution of the chosen place shall be indicated). After confirmation by the selected medical institution and the local medical insurance agency (the grade of the selected medical institution should be indicated), it will be submitted to the social security agency in the place where the insurance is taken care of for record.

(3) If a participant seeks medical treatment at the selected medical institution, or if he or she is transferred to a designated medical institution outside the administrative area of the city by the selected medical institution due to the need of his or her medical condition, the standard of the designated medical institution of the same level within the administrative area of the city shall be applied. Those who go to non-selected medical institutions on their own without transferring to other medical institutions shall be subject to the relevant provisions on hospitalization.

(4) for foreign medical procedures, outpatient medical treatment according to the outpatient outpatient fixed-point institutions of the costs (including the personal account of the insured employees) a sex into my financial account. That is: 156 yuan per person per year (13 yuan per month) for employees' health insurance, 20 yuan per person per year for residents' health insurance A class, 30 yuan per person per year for B class, and 100 yuan per person per year for C class.

How do I get reimbursed for medical treatment in a foreign country?

(1) Reimbursement of medical expenses for emergency hospitalization in other places.

If a participant is hospitalized in a medical institution outside the administrative area of the city for an emergency, the expenses will be paid in advance by the participant, and he/she will be reimbursed within 60 days after discharge from the hospital by presenting a certificate of diagnosis of disease, valid expense bills, a list of expenses for treatment, a copy of the discharge summary, a copy of the bank account number, and a copy of the identity card (or a copy of the household registration book) to his/her own medical institution or to a medical institution entrusted by the medical insurance operator. The reimbursement procedures will be handled at the social medical insurance agency or the medical institution commissioned by the social medical insurance agency. Those who give birth outside the administrative area of the city will follow this method, and are also required to provide proof of identity, marriage certificate and valid family planning certificate. The starting standard is determined according to the level of hospitals of the same grade within the administrative area of the city. For hospitals outside the administrative area of the city where the level cannot be determined, the starting standard for Level 3 hospitals within the administrative area of the city shall be applied, and the participant shall be responsible for the medical expenses within the starting standard. If a participant fails to provide reimbursement information according to the above requirements, the social insurance administration organization will not accept it. If the information provided by the participant lacks valid price information, the cost will be calculated according to the city's medical fee schedule.

If a participant is hospitalized outside the city for emergency treatment and needs to be transferred to another hospital due to his/her condition, he/she should be transferred back to the designated medical institution in the city if his/her condition permits; if he/she needs to be transferred to a local medical institution, he/she should also provide a certificate of transfer and summary of the condition of his/her illness issued by the transferring medical institution during the reimbursement formalities.

(2) Reimbursement of medical expenses for hospitalization at designated hospitals in other places.

1. Participants who have registered for off-site medical treatment shall have their individual accounts and outpatient co-ordination amounts transferred to them annually in accordance with the regulations for outpatient medical expenses, and no compensation will be made for any overspending;

2. Participants hospitalized in the selected hospitals shall pay the expenses in advance, and shall be reimbursed with the diagnosis of diseases, valid expense bills, list of treatment expenses, bank account number within 60 days after discharge from the hospital. A copy of the certificate of diagnosis of the disease, a list of treatment costs, a bank account number, and a copy of the ID card or a copy of the household register will be sent to the local social medical insurance office or a medical institution entrusted by the social medical insurance office for reimbursement. The starting standard is according to the standard of hospitals of the same level in the city, and the maximum payment limit of the basic medical insurance co-ordination fund is according to the standard of the city.

How to apply for medical insurance assistance?

Participants should be in the second year before June, the local social security agency or social security office to submit "Huizhou City, basic social health insurance assistance application form" (in duplicate) by the social security agency for approval, within 30 working days will be transferred to the applicant's financial account of medical insurance assistance. The deadline for application is December 31 of the second year.

XVIII. What are the criteria for transferring to the personal accounts of insured employees and the scope of use?

Participants in the comprehensive basic medical insurance establish individual accounts.

(1) Individual account consists of the individual contributions of the insured employees and the proportion of unit contributions according to different age groups. Specific transfer standards are: 35 years of age (including 35 years of age) of the following employees, according to their own contributions to 1% of the wage; 35 years of age to 45 years of age (including 45 years of age) of the employees, according to their own contributions to 1.3% of the wage; 45 years of age to the pre-retirement of the employees, according to their own contributions to 2% of the wage into the retirement; retirees according to their own contributions to the wage (one-time pontoon contributions to the city's citywide social average wage) 4.5% of the wage) to the retiree. Retirees are entitled to 4.5% of their contributory salary (or the previous year's average salary in the city for one-time lump sum contributions). The employer's contribution to the employee's civil service medical subsidy will be transferred to the employee's personal account.

(2) The individual account can be used to pay for the medical expenses incurred by the spouse, parents or children of the insured employee at the designated medical institutions in the city, and the costs of medicines in accordance with the policy incurred in purchasing medicines at the designated retail pharmacies, as well as the costs of preventive vaccines (except for those free of charge according to the regulations), and the costs of health check-ups.

(3) When an insured employee dies or transfers to another place, the balance of his/her individual account can be withdrawn in cash and the medical insurance relationship is terminated. If the insured employee goes through the procedure of medical treatment in a different place, the individual account will be transferred to his/her financial account in the form of cash every year.

What are the regulations for specific outpatient treatment?

(1) Only after the insured employee has paid contributions for six consecutive months (excluding six months) can he/she apply for specific outpatient treatment and enjoy the specific outpatient treatment after approval. The maximum payment limit of the Employee Medical Insurance Coordination Fund for specific outpatient expenses and inpatient medical expenses within the year are calculated separately.

(2) Insured residents may apply for specific outpatient treatment only from the month following the month in which they enroll and pay the premiums, and will be entitled to specific outpatient treatment upon approval. The maximum payment limit of the residents' medical insurance fund for specific outpatient medical fees and hospitalization costs within a year is calculated cumulatively, and if the maximum payment limit of the residents' medical insurance fund for that year is exceeded, the residents' medical insurance fund will no longer pay the medical fees for that year. And you can only seek medical treatment at designated medical institutions within the administrative area of the city.

(3) For specific outpatient treatment, the participant shall apply for specific outpatient treatment at the local social security office with the relevant certificates issued by the designated medical institutions designated by the social security office after reviewing the relevant information. Participants are entitled to different specific outpatient treatment according to the mode of participation and the standard of contribution.

Participants suffering from specific outpatient diseases can apply for specific outpatient treatment if they meet the requirements. Participants should apply for specific outpatient treatment at the local social security agency with the "Huizhou Basic Social Medical Insurance Application Form for Specific Outpatient Treatment" issued by the designated medical institution designated by the social security agency and relevant information. The designated medical institution designated by the social security agency to handle the application for specific outpatient treatment shall strictly implement the relevant regulations of the labor security administrative department and the social security agency on specific outpatient treatment, and shall not issue relevant certificates and documents for the participants who do not meet the prescribed conditions.

After the application for specific outpatient treatment is approved, the insured person can go to the designated designated medical institution for consultation and purchase of medicines.

After a participant switches health insurance policies, the specific outpatient treatment will be implemented according to the provisions of the new health insurance policy.

The medical insurance fund will not pay for medical expenses in the following cases:

(1) those who go to non-designated medical institutions (except for emergencies) or retail pharmacies in the city for consultation and purchase of medicines;

(2) those who suffer injuries due to their own illegal and criminal behaviors, or due to their own intentional behaviors, such as self-inflicted injuries, assaults and battery, alcoholism, unlicensed driving of motor vehicles, ships and aircraft, and those who belong to the responsibility of other parties;

Accidental injuries;

Accidents and injuries of the participants are not covered by the medical insurance fund. Accidental injuries;

(3) Medical expenses incurred for work-related injuries, childbirth (excluding residents' medical insurance), and medical accidents;

(4) Medical expenses incurred for cosmetic surgeries or corrective treatments for congenital disabilities that are not necessary for physiological functions;

(5) Preventive health care and recuperative treatment;

(6) Expenses incurred when traveling abroad for official or private purposes, or when traveling to Hong Kong, Macao, Taiwan, or other regions;

(7) Expenses incurred during the period of travel to Hong Kong, Macao, Taiwan, or other regions.

(vi) medical expenses incurred during traveling abroad for business or private purposes and to Hong Kong, Macao, Taiwan and other regions;

(vii) other expenses that cannot be paid by the medical insurance fund in accordance with the relevant provisions of the state, provinces and municipalities.

What are the provisions for accidental injuries

The medical insurance fund shall pay for accidental injuries under one of the following circumstances:

(1) the responsibility of the party who has been injured (excluding work-related injuries, suicides, self-inflicted injuries, alcoholism, traffic accidents and injuries caused by such accidents and injuries resulting from other unlawful behaviors);

(2) the public security department is unable to determine the person who is responsible for the injuries or the The responsible person is not capable of making compensation;

22. What are the designated hospitals within the administrative area of the city that have the qualification of transferring hospitals?

Huizhou Central Hospital; Huizhou Hospital of Traditional Chinese Medicine; Huizhou Third People's Hospital (formerly Huizhou People's Hospital); Boro County People's Hospital; Longmen County People's Hospital, Huidong County People's Hospital; Huiyang District People's Hospital.

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