According to the active employees of the previous year's gross salary of 8% of the unit to pay, individual contributions of 2%, a total of 10%.
Division of funds:
Hospital funding channels are divided into: the basic medical gold, medical equipment and equipment purchases of two parts (5 million yuan per year)
Medicare fund: personal account + co-ordinated gold, each year, roughly 20 million personal account co-ordinated gold 40 million.
Unified fund == enterprise 8% - (1% + 1.4% + 3.7%), personal account == personal 2% + (1% + 1.4% + 3.7%).
Individual account: mainly used to pay outpatient + pharmacy costs;
Coordinated payment: mainly used for hospitalization costs, chronic diseases and large-scale inspection into the integrated.
Two medical aid special fund:
1) at the end of the year according to the total number of registered employees and retirees per person 80 yuan of the standard composition of the withdrawal, divided into large medical aid (35 - 150,000) and difficult medical aid.
2) in a year, the health insurance co-ordination fund maximum payment limit of 35,000 yuan, large medical aid payment limit of 35,000 yuan to 150,000 yuan, more than 150,000 yuan part of the basic medical insurance no longer bear the burden of the leadership to decide.
3) Large medical aid: the insured workers incurred in the year in line with the provisions (35,000 to 150,000 yuan) of medical expenses. Payment ratio: 80% for the first year of participation; 85% for more than two years; retirees are treated 5 percentage points higher than active employees.
4) Difficulties in medical assistance: the insured employees in the year in the designated hospitals, in line with the provisions of the personal burden of the expenses exceeded more than 50% of their annual gross salary (half a year's salary). At the end of the year by each unit to report materials - medical insurance center review ---- reported by the group company's medical insurance leading group review and approval of ---- aid eligible employees in difficulty.
Three treatment cost mode:
1) outpatient: mainly use personal account, the integrated fund can pay for outpatient chronic diseases and large-scale inspection into the integrated proportion of the project.
2) Hospitalization:
a) Starting standard:
Second class A (and third class) hospitals: 400 for in-service, 300 for the second time and beyond, and 200 after 300 for retirement. only the main hospital and the outward transfer, the hospitals of the other side of the second class B (and first class) hospitals: 300 for in-service, 200 for the second time and beyond, and 100 after 200 for retirement.
b) The part above the starting standard is paid by the individual and the co-ordinated fund in proportion to the out-of-pocket expenses:
Above the starting standard from 0 to 10,000 yuan, the individual out-of-pocket expenses are 15% for the active employees and 7.5% for the retirees; above 10,000 yuan up to the ceiling line (35,000 yuan), the individual out-of-pocket expenses are 10% for the active employees and 5% for the retirees.
3) Use of materials:
Participating employees enjoying basic medical care (0---35,000 yuan), the use of domestically produced materials, 100% into the integrated reimbursement; joint venture materials individual out-of-pocket payment of 10%, the bulk of the payment of 30%, the integrated proportional payment of 60%; imported materials individual out-of-pocket payment of 10%, the bulk of the payment of 40%, the integrated proportional payment of 50%;
When enjoying large medical aid (35,000 - 150,000), the individual pays 10% for the use of imported and joint venture materials, and the remaining 90% is paid by the large amount according to the prescribed proportion.
4) Drug Management:
a) Use of Class A drugs 100% into the integrated reimbursement scope, paid in proportion.
b) Class B drugs by the insured employees to pay 10% of the other 90% = = Class A drugs
c) the use of Class B drugs ---- should first obtain the consent of the employees and sign an agreement ---- without signing an agreement on the cost of medicines ---- the insured employees can refuse to pay the individual ---- health insurance fund will not be paid.
d) hospitals use Class B drug costs, not more than 50% of the total drug costs of the hospitalization; self-financed drug costs not more than 10% of the total drug costs of the hospitalization, the hospital must ensure that more than 90% of the medical insurance drugs
Four employees individual medical insurance account interest
Employee personal health care account interest accrued by the specific methods of calculating the interest rate ---- tentatively calculated in accordance with the current year's bank announced the interest rate on demand deposits. The interest rate is calculated according to the interest rate of demand deposits announced by the bank in the current year.
V Chronic Disease Management:
After the identification of the chronic disease employees recorded in the health insurance network, after the exhaustion of the individual account, the active employees will pay 400 yuan out-of-pocket, and the retirees will pay 300 yuan out-of-pocket, and they can enter into the integrated system. Each time the cost of ----- the insured employees to pay 20% out of pocket by the proportion of the integrated fund. (The maximum payment limit of outpatient co-ordination fund for multiple chronic diseases at the same time is 500 yuan for each additional type, up to a maximum of 5,000 yuan. Outpatient chemotherapy and radiotherapy for malignant tumors, dialysis for patients with uremia, and anti-discharge treatment after organ transplantation are not subject to the outpatient maximum limit, and do not bear the 20% starting paragraph, and will be paid by the coordinated fund on a pro rata basis. Chronic disease costs incurred on an outpatient basis are counted towards the maximum payment limit (0 to 150,000) of the integrated fund.
Six family members medical management:
Corporate employees dependent immediate family members (including only child) in the event of illness, can be entitled to 1/2 of the medical expenses of the active employees.
Outpatient treatment: the employee's family members can swipe the card in the outpatient clinic Pharmacy purchases, the current year's personal account will not be carried forward and inheritance. Employee family members hospitalization transfer in accordance with 1/2 of the reimbursement scope of active employees.
Seven referral and transfer of medical expenses settlement and process
1) Transfer to the designated hospitals: the Group has tentatively decided on four Bengbu Medical College Hospital; Anhui Medical University Hospital; Nanjing Military Region General Hospital; Xuzhou Second Hospital. When reimbursement is made, the individual first pays 10% of the amount that meets the requirements for medical insurance payment, and the other 90% is reimbursed according to the proportion. If the patient is transferred to a non-designated hospital, the individual pays 50% and the other 50% is reimbursed on a pro rata basis.
2) For those who are suffering from serious specialized diseases, which cannot be treated in general hospitals or for which there is no good treatment, and are recommended by the designated hospitals to be transferred to specialized non-designated hospitals for treatment, reimbursement can be made on the basis of the designated hospitals (90% of the reimbursement enters into the reimbursement).
3) Business trips and legal family leave Emergency: If you are hospitalized in a non-scheduled hospital due to an emergency, you can go to the scheduled hospital for reimbursement with the hospital's emergency medical records, valid invoices, a list of medical expenses, and proof of the unit and a copy of the round-trip ticket from the place where you are going out after you have completed the treatment, and you will be reimbursed for the expenses you incurred in the scheduled hospital, with 10% of the expenses that meet the requirements of the Basic Medical Care Coordination Fund to be reimbursed in accordance with the provisions of the law. The rest will be reimbursed according to the regulations.
Eight:
The conditions of medical treatment in other places:
1. retired workers, due to the need of life, the household registration is moved to other places and live in other places for a long time. 2. retired workers, due to the lack of children around them, reside in their children's place in other places for more than one year. 3. the unit is sent to other places and work in the field for a long time for more than one year. Reimbursement for medical treatment in a different place: the individual pays 10% out of pocket first, and the rest is reimbursed according to the proportion.
Nine birth control four surgery management:
Four birth control surgery refers to the IUD, IUD removal, ligation, termination of pregnancy ----- object of the company's employees and their married immediate family members. ---- Procedures:Anyone who needs to implement the four surgeries, you need to hold a certificate from the birth control office of your unit and your medical insurance card ----- to the designated hospitals in the unit to implement the cost of booking processing.
Ten medical insurance cost settlement:
Medical insurance management department of the hospital costs incurred in accordance with the provisions of the audit, will be audited in accordance with the provisions of the payment of costs reported to the assets of the Department of Finance as the basis for disbursement. Ninety percent of the unified fund is used by the general hospital as a lump sum, and the other 10 percent is honored by the medical insurance management department after the assessment (conducted in January of the following year), and the individual account fund is settled according to the facts.
Related contribution base Ratio:
Individual employees will use their 2005 average monthly salary income (including bonuses and allowances) as their contribution base for the year 2006, and the insured units will use the sum of the contribution base of all individual employees of the unit as their contribution base.
Pension insurance contribution rate: 18% for the unit, 8% for the individual
Unemployment insurance contribution rate: 2% for the unit, 1% for the individual
Medical insurance contribution rate: 8% for the unit, 2% for the individual
Worker's compensation insurance contribution rate: the unit in accordance with the 2006 Worker's Compensation Insurance Rate Adjustment Measures
Workers' Compensation Insurance contribution rate: the unit in accordance with the 2006 Worker's Compensation Insurance Rate Adjustment Measures