Hello! Hohhot City, urban residents of major illness supplemental insurance work will be launched on January 1, 2015 implementation, and strive to 2015, the average actual reimbursement ratio of major illness supplemental insurance is not less than 50%. Basically established a reasonable financing mechanism, sound management system, operation standardized urban residents of major illness supplemental insurance system.
The financing standard for urban residents' major illness supplemental insurance is raised at 35 yuan per capita, of which 20 yuan per person per year for urban insured residents is used for major illness supplemental insurance, and the shortfall is transferred from the residents' basic medical insurance fund to the major illness supplemental insurance fund at a standard of 15 yuan per person. The residents themselves will not make separate contributions.
The supplemental insurance fund for urban residents' major illnesses is based on the principles of determining expenditures based on income, balancing income and expenditures, and having a slight surplus. The supplemental insurance for urban residents with major illnesses establishes a starting standard and a maximum payment limit. The starting standard is the disposable income of urban residents in the previous year, and the maximum payment limit is set at 100,000 yuan.
The supplemental insurance for major illnesses of urban residents is represented by commercial insurance organizations. The commercial insurance agency is determined through government bidding. It is stipulated that the profit rate of the agent commercial insurance organization is controlled within 5%, and all the remaining costs of the actual payout lower than 95% of the payout target will be returned to the supplemental insurance fund for urban residents with major illnesses.
Adjustment of urban workers' basic medical insurance
Outpatient co-ordination settlement management methods
The urban workers' basic medical insurance outpatient co-ordination settlement management methods have been adjusted in four aspects, and will be implemented from January 1, 2015 onwards. The adjustments have raised the outpatient coordination reimbursement rate from 50% to 60% for Level III hospitals and from 50% to 80% for hospitals below Level II.
The fixed-point hospitals for chronic diseases have been relaxed, from only being able to visit second-level hospitals to being able to visit third-level hospitals.
Canceling the declaration of Class B chronic diseases, raising the outpatient coordinated payment limit, Class B chronic diseases below 4,000 yuan (including 4,000 yuan) and general outpatient clinics are on a par with the standard of 4,000 yuan. The original higher than 4000 yuan limit of chronic diseases of category B adjusted to category A chronic diseases, the implementation of the declaration of the record at any time.
The starting standard for outpatient coordination is set at a cumulative payment of 1,000 yuan in a year.
Clarifying and adjusting urban workers' health insurance
Related policies on municipal coordination
In the Notice on Relevant Issues in the Implementation Process of Municipal Coordination of Urban Workers' Basic Health Insurance, which was released and implemented on October 28, 2013, the issues related to municipal coordination of urban workers' health insurance were further clarified and adjusted, including six specific aspects:
(a) after the retirement of individual insured persons who have contributed 8% of the total account combined, the basic medical insurance premiums for the remaining years will be paid by the person himself as a lump sum of 6% based on 80% of the average salary of the employees on the job in the previous year in the city, and he will be able to enjoy the medical insurance treatment of the total account combined after his retirement; the individual insured persons who have contributed 4.5% of the total account combined for inpatient hospitalization, will continue to make a lump sum of 4.5% of the total account combined for hospitalization and enjoy the medical insurance treatment of the hospitalization combined for the rest of his life, without establishing the medical insurance treatment of the hospitalization combined. After retirement, individual insured persons who have contributed at the rate of 4.5% for hospitalization coordination will still make a one-time contribution at the rate of 4.5% and enjoy the medical insurance treatment of hospitalization coordination without establishing individual accounts. If it is difficult to pay the one-time contribution, they can pay the contribution year by year according to the contribution standard of the active employees, and they will not pay any more contribution after they have paid the full amount of the remaining years. If an individual participant has information on both 8% and 4.5% contribution standards before retirement, the standard at the time of the last contribution will be the post-retirement contribution standard.
(2) The land requisitioned farmers who have gone through the retirement procedures, according to the provisions of the municipal government's Decree No. 1 of 2011, will pay the 20-year basic medical insurance premiums and large medical insurance premiums in a lump sum of 6% or 4.5% of the contribution base in the year of enrollment, and will enjoy the corresponding medical insurance treatment after retirement. Those who have not reached the retirement age will pay the basic medical insurance premiums and the large medical insurance premiums in three age groups according to 4.5% of the contribution base in the year of participation.
(c) outside the integrated area (including the autonomous region level) to pay basic medical insurance premiums can be calculated cumulatively, but in the city's actual participation in the premiums for a period of not less than 20 years. The participants of the municipal flag county transferred to the municipal level, the years of contributions in the flag county can be calculated continuously, and the accumulated years of contributions shall be not less than 20 years if they have reached the legal retirement age. If the urban residents' medical insurance is transferred to the urban workers' medical insurance, every one year of contribution that has been paid to the urban residents' medical insurance can be converted into two months of contribution by the urban workers.
(4) The continuous military service or working years before December 31, 2004 is calculated as the number of years of contributions, and the actual cumulative number of years of contributions in the city is not less than 15 years if he/she reaches the legal retirement age. Those who have not paid the full 15 years can pay the medical insurance premiums according to Article 18 of the 2011 Government Decree No. 1 and enjoy the retiree medical treatment.
(E) adjust the starting standard of the hospitalization fund of the employee health insurance, the first hospitalization of the insured in the designated institutions within one year: 1000 yuan for the three A hospitals, 800 yuan for the three B hospitals, 500 yuan for the second level hospitals, 300 yuan for the hospitals below the second level and the community health service centers. The starting payment standard for second and third or more hospitalizations is still implemented as stipulated in Government Decree No. 1 of 2011. Those who are transferred from outpatient treatment to hospitalization will be charged at the one-time starting payment standard.
(F) At the same time that the Notice on Issues Related to the Implementation Process of Municipal Integration of Urban Employee Basic Medical Insurance was issued, the document "Notice of the People's Government of Hohhot City on the Issuance of <Measures for the Medical Insurance of Agricultural and Non-Affiliated Personnel on Expropriated Land in Hohhot City>" (Hohhot Zheng Fa [2007] No. 4) was repealed.
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