Article 1 for the protection of basic medical care for urban residents, further improve the health insurance system, build a harmonious society, according to the State Council "on the development of basic medical insurance for urban residents of the pilot guiding opinions" (Guofa [2007] No. 20), the Hebei Provincial People's Government "on the establishment of the implementation of the basic medical insurance system of urban residents of the views" (Ji Zheng [2007] No. 99), Hengshui City The implementation of basic medical insurance for urban residents (Hengzheng [2009] No. 44) and other documents, combined with the actual situation in our county, hereby formulate the implementation of the rules.
The second basic medical insurance system for urban residents, adhere to the principle of low level, wide coverage, the different levels of groups of medical care to make appropriate institutional arrangements, according to the level of economic development and the ability of all parties to reasonably determine the financing standards and levels of protection, with a focus on protecting the residents of hospitalization and outpatient medical needs; adhere to the principle of the family as a unit, the masses of people voluntarily, individual contributions and government assistance Adhere to the principle of combining family-based, voluntary, individual contributions and government subsidies; adhere to the principle of coordination, unified management, and to do a good job of the various types of medical insurance system between the basic policies, standards and management measures of convergence.
Article 3 of the basic medical insurance for urban residents to the county as a coordinating unit, the county government is responsible for the unified coordination and management. The county government set up the urban residents basic medical insurance leading group, responsible for the organization and coordination and macro-guidance, research and formulation of relevant policies and supervise and check the implementation of the policy, coordinate and solve the problems arising from the work. All relevant departments closely cooperate, *** with the urban residents to do a good job of basic medical insurance.
Article IV of the County Personnel, Labor and Social Security Bureau is the residents of the work of the administrative department in charge of the work of medical insurance, is responsible for urban residents of the formulation of basic medical insurance policy, implementation, management and supervision; County Bureau of Finance is responsible for the budgetary arrangements for the financial subsidies and allocation of funds to strengthen the supervision and management of the fund is responsible for the implementation of the funds to ensure that the urban residents of the basic medical insurance agencies to start up the necessary funds and included in the financial budget; County Health Bureau is responsible for the budgetary arrangements and allocation of funds to strengthen fund management and supervision, is responsible for the implementation of the funds required for urban residents of basic medical insurance agencies. Financial budget; County Health Bureau is responsible for the supervision of medical institutions, improve the construction of community health service institutions, for the insured residents to provide quality and affordable basic medical services; County Education Bureau is responsible for publicity and mobilization of organizations in the school primary and secondary school students and nursery school children to participate in the work of the insurance, the implementation of the target responsibility system, the responsibility for the school, the kindergarten to do the insured to ensure that all insured; the county public security bureau is responsible for the determination of the household registration of the insured personnel and to provide the relevant basic data And timely provision of newborns settled information; County Civil Affairs Bureau is responsible for low-income objects and low-income families older than 60 years of age identification, with the Department of Labor and Social Security to do a good job of the special hardship group of data statistics and registration; County Federation of Disabled Persons is responsible for the loss of the ability to work the identity of persons with severe disabilities (1?2), with the Labor and Social Security Department to do a good job of the disabled persons with the registration of the insurance work; townships and townships are responsible for the urban residents within the jurisdiction of the townships and townships to publicize the insurance work. Township government is responsible for the township residents within the jurisdiction of the publicity and mobilization, insurance work; County Development and Reform Bureau, Food and Drug Administration and other departments are responsible for the development of relevant supporting policies and measures to assist in the work of basic medical insurance for urban residents. The above departments should do a good job in accordance with their respective responsibilities to start the work of basic medical insurance for urban residents.
The county medical insurance center is specifically responsible for the county's urban residents' basic medical insurance operation, and undertakes the work of urban residents (except schools and kindergartens) in the county to participate in the insurance. Township labor security service stations, schools for urban residents of basic medical insurance agency, under the guidance of the Department of Labor and Social Security, specifically responsible for residents to participate in the mobilization of publicity, registration, qualification examination, basic information entry, change, summary report and medical insurance, IC card issuance and so on.
Chapter 2, the scope of insurance
Article 5 of the administrative region, not participating in the basic medical insurance of urban workers, non-employed urban residents can voluntarily participate in the basic medical insurance for urban residents. Including:
(a) primary and secondary school students (including vocational education centers, high schools, junior high schools, elementary school students and nursery school children)
(b) 18 years of age (including 18 years of age) of the following non-school residents;
(c) 18 years of age or older of the non-working urban residents.
Article 6 Other people who are in line with the relevant national and provincial policy regulations and the spirit of the document may voluntarily participate in the basic medical insurance for urban residents. Including:
(1) flexible employment, urban workers;
(2) closed down bankruptcy enterprise retirees (including retirees who do not participate in the basic medical insurance for urban workers), closed down bankruptcy enterprise employees.
Chapter III financing standards and subsidies
Article 7 of the participants in addition to the central and provincial financial subsidies, the shortfall will be made up by the county finances.
Article VIII
(a) all types of students, 18 years of age and under, non-school residents, health insurance premium financing standards for each person 160 yuan per year (including large medical insurance premium of 10 yuan), the individual to pay 30 yuan, the rest of the central, provincial, and county finances to make up the full amount.
(2) The financing standard for health insurance premiums for urban residents over 18 years old is 300 yuan per person per year (including 50 yuan for large medical insurance premiums). Individuals pay 170 yuan, and the rest is made up by the central, provincial and county finances. (In 2009, the standard for the second half of the medical insurance premium for residents over 18 years of age was 85 yuan for individual payment, including 25 yuan for large medical insurance premium).
The medical insurance premiums for low-income recipients among the above people, residents with severe disabilities (level 1-2), and elderly people over 60 years old in low-income families are all covered by the financial subsidy funds, and in addition to the central and provincial financial subsidies, the remaining portion of the premiums is subsidized by the county financial subsidies.
Article IX of the conditions of the employer can be subsidized for employees' family members to participate in insurance contributions, unit subsidies in the pre-tax funds.
Chapter IV registration and fund collection
Article 10 of the various types of students, nursery school and kindergarten assigned by the school and kindergarten as a health care administrator, unified organization for insurance procedures. Students, nursery school children to register for the insurance should provide ID card number, I small two-inch recent color photographs. Schools, kindergartens should be in a timely manner to participate in the basic information, collected on behalf of the medical insurance premiums, unified report to the county health insurance center or designated bank account.
Urban residents with a household register, ID card and a copy of the original, I small two-inch recent color photo (children before kindergarten may not provide a photo), to the county health insurance center, the township labor security service station to handle the procedures for participation and payment of premiums. After the county health insurance center and the township labor security service station have examined and approved the residents' declaration information, they will print out the payment documents for the insured residents and go through the relevant registration procedures, and the insured residents will pay the medical insurance premiums to the bank account designated by the health insurance center.
The following people are required to hold valid certificates of low income guarantee and severe disability certificate (original and 1 copy) issued by the civil affairs or disability association departments at the same time, and then go to the county medical insurance center to apply for the insurance procedures directly after the registration department has posted a public notice with no objections:
(1) low income guarantee recipients;
(2) urban residents with severe disabilities (including all kinds of students);
(C) annual per capita income of less than one-third of the annual per capita disposable income of residents of the county in the family over 60 years old (to provide the Civil Affairs Bureau issued by the low-income family identification certificate).
Article 11 of the insured residents to the family as a unit, in line with the basic health insurance for urban residents shall be insured at the same time (has participated in the basic health insurance for urban workers and the new rural cooperative medical care except for those who), all types of students to the school as a unit of the insurance, the collective for the insurance procedures.
Article XII of the newborns from the date of household registration within three months for insurance procedures.
Article 13 of the urban residents of medical insurance to implement a one-year lump-sum advance payment system, a year for a medical treatment payment period.
(1) All types of students, nursery school children pay fees according to the school year, at the beginning of each school year for registration and change of information related to the insurance, pay the basic medical insurance premiums for the current school year, October 1 of that year to September 30 of the following year for the payment of medical insurance benefits.
(2) Non-school residents under the age of eighteen and urban residents over the age of eighteen pay their contributions on an annual basis. From September 1 to October 31 each year, the centralized registration, pre-payment and change of information on residents' health insurance. 2009 half-yearly health insurance premiums and reimbursement of medical expenses for the second half of the year, 2010 annual health insurance premiums in January 2010, and thereafter every year from September to October to collect the health insurance premiums, the following year from January 1 to December 31 for the period of payment of health insurance entitlements.
Article XIV of the county health insurance center in November 30 each year, the number of insured residents and the amount of financial subsidies reported to the financial sector, the financial sector included in the next year's budget. The financial sector in the following year before the end of January, the financial subsidies will be allocated to the county health insurance center financial account.
Article 15 of the basic medical insurance for urban residents to build only a comprehensive fund, not a personal account.
Article 16 of the urban residents of basic medical insurance contributions into the integrated fund will not be refunded.
Chapter V medical insurance treatment
Article 17 of the basic medical insurance for urban residents to implement the basic medical insurance for urban workers in Hebei Province, the drug list, diagnosis and treatment catalog, medical service facilities and standards and other relevant provisions, based on which the appropriate increase in the variety and scope of children's medication. In addition to the part of the costs incurred by the hospitalization by the individual part of the direct settlement with the designated medical institutions, the remaining part of the county medical insurance center and the designated medical institutions settlement.
Article 18 of the integrated fund payment scope includes:
(1) payment of non-student urban residents in line with the provisions of the basic medical insurance for urban residents of hospitalization costs and malignant tumors outpatient radiotherapy, uremia outpatient dialysis, and liver, kidney transplantation and anti-rejection drugs incurred in the outpatient costs;
(2) payment of all types of students, 18 years of age and under the non-student population Hospitalization expenses for diseases and accidents, outpatient radiotherapy for malignant tumors, outpatient dialysis for uremia and outpatient expenses incurred by taking anti-rejection drugs after liver or kidney transplantation, aplastic anemia, and hematological diseases in remission of leukemia.
Article 19 of the urban insured residents need to bear a certain amount of medical expenses, i.e. the starting standard, each time they are hospitalized. The starting standard is determined according to the different levels of medical institutions: 300 yuan for first-degree designated medical institutions (including designated community health centers), 500 yuan for second-degree designated medical institutions, and 700 yuan for third-degree designated medical institutions.
The hospitalization reimbursement rate for insured residents is 70% for designated first-level medical institutions (including designated community health centers), 60% for designated second-level medical institutions, and 50% for designated third-level medical institutions above the starting standard.
The maximum payment limit of the integrated fund is 30,000 yuan per person per year.
Article 20 of the basic medical insurance for urban residents to pay part of the cost of diagnostic and treatment items, as well as the use of basic medical insurance for urban residents in the drug list of the "Class B list of drugs", the individual first paid 10%, and then 90% of the remaining 90% by the individual and the coordinated fund in accordance with the prescribed ratio.
Article 21: If an insured resident needs outpatient treatment for outpatient radiotherapy for malignant tumors, outpatient dialysis for uremia, and anti-rejection medicines after liver or kidney transplantation (all kinds of students and non-college residents aged 18 years old and below, including aplastic anemia, leukemia in remission, and blood diseases), he or she shall hold his or her own medical card, a recent diagnosis certificate of a designated medical institution at or above the second level, a copy of his or her inpatient record, and relevant tests, laboratory tests, and other relevant documents. A copy of the medical certificate (IC card), recent diagnostic certificate of the designated medical institution above the second level, hospitalized medical record, and relevant test and laboratory reports, etc., shall be submitted to the Labor and Social Security Department for recognition, and then receive the "Outpatient Medical Certificate for Special Diseases of Urban Residents' Basic Medical Insurance", and then go to the designated medical institution with the certificate for medical treatment, and the outpatient treatment shall be included in the scope of the payment of the Urban Residents' Basic Medical Insurance Fund, with a starting standard of RMB 500 yuan per year. The hospitalization regulations are implemented.
Article 22 of the contribution period and medical insurance treatment linked. Every five years of continuous contributions by insured residents, the urban residents' basic medical insurance fund will increase the payment ratio by 3%, with a cumulative maximum of 9%. Participating residents to interrupt the payment of contributions, re-enrollment in accordance with the new participants to recalculate the number of years of contributions.
Article 23 refers to the operation of large medical insurance for urban workers, large medical insurance for urban residents is integrated at the municipal level, and the municipal medical insurance agency is unified with commercial insurance companies. The part of hospitalization and outpatient expenses of the insured exceeding the maximum payment limit of the urban residents' basic medical insurance co-ordination fund, medical expenses in accordance with the provisions of the basic medical insurance shall be paid 75% by the large medical insurance for category A, and individuals shall pay 25% out of pocket, and 10% out of pocket for category B, and then paid in accordance with the same ratio. The maximum payment limit for large medical insurance in a settlement year is 70,000 yuan.
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