(a) Outpatient major illness (first category) comprehensive medical insurance outpatient, designated retail pharmacy general basic medical costs and local supplementary medical costs are settled according to the service items; (b) Inpatient medical insurance, migrant workers' medical insurance outpatient basic medical costs are fixed at a fixed amount according to the number of bound participants; (c) Outpatient large-scale medical equipment examination and treatment costs are settled according to the approved (c) Outpatient large-scale medical equipment examination and treatment costs are settled according to the approved outpatient average cost reimbursement standard; (d) Outpatient blood dialysis basic medical costs and local supplementary medical costs are settled according to the total cost reimbursement standard stipulated in the relevant agreement; (e) Basic medical costs of prenatal checkups for maternity medical insurance participants are settled according to the service items; (f) General inpatient basic medical costs and local supplementary medical costs are settled according to the service unit and combined with the standard ratio of inpatient outpatient visits; (g) Inpatient basic medical costs for some types of illnesses or treatment items are settled according to the service unit and combined with the standard ratio of inpatient outpatient visits; and (vii) Inpatient basic medical costs and local supplementary medical costs for some diseases or treatment items are settled according to the reimbursement standard for the disease; (viii) Inpatient basic medical costs and local supplementary medical costs for schizophrenic patients who have been hospitalized for a long period of time are settled according to the annual lump-sum payment; (ix) If the basic medical insurance and local supplementary medical insurance costs for the hospitalization of a participant exceed the average hospital inpatient reimbursement standard by more than four times, the participant will be reimbursed separately, of which 90% will be paid according to the service unit and combined with the service outpatient visit ratio standard. reimbursement, of which 90% is settled by service item and 10% is settled by service unit; costs below four times the average hospital inpatient cost reimbursement standard are settled by service unit; (x) other cost settlements are settled in accordance with the agreement.
Legal Objective:Medical insurance is a kind of insurance to compensate for medical expenses caused by illness. Employees due to illness, injury, maternity, social insurance by the community or enterprises to provide the necessary medical services or material help. Such as China's public medical care and labor insurance medical care. The medical expenses of Chinese employees are borne by the state, the organization and the individual*** together, in order to reduce the burden on enterprises and avoid waste. (A) declaration acceptance of the medical insurance agency collection department accepts the insured unit to fill in the "medical insurance contribution base change declaration form", and require the following information: 1. payroll details; 2. "participate in the medical insurance personnel increase or decrease in details" 3. medical insurance agency stipulated in other information. (ii) contribution approval 1. medical insurance institutions, the collection department to audit the participating units to fill in the contribution declaration approved form and related information. After passing the examination and approval, the procedures for the approval or increase or decrease of participants are carried out. 2. The collection department of the health insurance organization records the time of enrollment, current contribution salary and other information for the new participants in a timely manner according to the declaration and approval of contributions. The collection department of the health insurance organization approves the current contribution base according to the declaration of the insured unit. 3. The collection department of the health insurance organization calculates the amount to be paid according to the approved current contribution base and contribution rate of the insured unit, and prints out the Notice of Medical Insurance Contribution to give back to the declaring unit, and collects the fee on this basis. (C) fee collection 1. Health insurance institutions through the "income account deposits" account bank charges, but also can take a check, cash, wire transfer, cashier's checks and other means of charging, and issue a special receipt. The financial management department of the health insurance organization reconciles and settles the account with the bank every month and gives feedback to the collection department on the arrival of the account. 2. Based on the feedback from the financial management department on the payment of medical insurance premiums, the collection department of the health insurance organization issues a "Reminder of Social Insurance Premiums" to the insured units that have not paid the full amount of the premiums or the premiums in a timely manner after filing the declaration. If the notice is not complied with after the deadline, the relevant circumstances and information will be provided to the labor security administrative department, and the labor security administrative department will make corrections within a certain period of time. 3. By the 25th day of each month, if a participating unit delays in paying the premiums, it will be charged a late fee of 2 per thousand per day from the date of the delinquent payment. May be a one-time payment of a month, a quarter, half a year or a year. If the contribution is made quarterly or annually, it shall be paid from the beginning of the quarter or the beginning of the year. If you are temporarily unable to pay, apply for deferred payment, and the deferred payment time shall not exceed 2 months. (d) Repayment of arrears 1. The collection department of the health insurance organization establishes data information on arrears based on the situation of arrears in medical insurance, fills in the Notice of Repayment of Social Insurance Premiums, and notifies the insured unit to make up for the arrears. 2. For the insured unit that is not able to pay its arrears in full at one time due to difficulties in raising funds, the collection department of the health insurance organization enters into an agreement on the repayment of social insurance premiums with the insured unit. If a unit in arrears of contributions is merged, separated, or goes bankrupt, it will sign a supplementary contribution agreement in the following manner. (1) If the unit in arrears is merged, sign a retroactive contribution agreement with the merging party. (2) If the delinquent unit is separated, a retroactive payment agreement is signed with each of the sub-parties. (3) If the delinquent unit enters into bankruptcy proceedings, a liquidation agreement is signed with the liquidation group. (4) If the unit is sold or leased by auction, sign a retroactive payment agreement with the competent authority. 3. If the insured unit handles retroactive payment in accordance with the "Notice of Replacement of Social Insurance Premiums" or the retroactive payment agreement, the collection department of the health insurance organization will accept the application and notify the financial management department of the health insurance organization to collect the payment. 4. If the insolvent unit is unable to fully liquidate its arrearage of fees, the collection department of the health insurance organization will accept the application submitted by the insolvent liquidation group of the unit, and then review the application before sending it to the audit 5. The collection department of the health insurance organization will adjust the information about the arrears of the insured units based on the information about the arrival of the arrears of payment from the financial management department and the information about the write-off from the audit and supervision department.