Basic medical insurance for urban residents refers to a social insurance system implemented among urban residents in China, aiming to provide basic medical protection for urban residents. The insurance system was first piloted in 1998 and was fully rolled out in 2007, and has gradually become an important part of medical insurance for urban residents.
The main goal of the basic medical insurance for urban residents is to solve the problem of urban residents becoming poor and returning to poverty due to illness, and to raise the level of medical protection for urban residents. Participants in the insurance system include non-working urban residents, the rural transfer population, and temporary urban residents, and those with urban household registration or long-term residence permits are eligible to participate.
The basic medical insurance for urban residents is financed by individual contributions, government financial subsidies and other sources of income. Participants are required to pay a certain amount of premiums each year, the exact amount of which is determined by each region according to the actual situation. At the same time, the government also provides certain financial subsidies to participants to ensure the sustainable operation of the insurance system.
While enjoying the urban residents' basic medical insurance, the insured can seek medical treatment at designated medical institutions and enjoy a certain amount of reimbursement of medical expenses. The specific reimbursement rate and scope are determined by localities according to the actual situation, and generally include outpatient expenses, hospitalization expenses, surgical expenses, and drug expenses. Participants are required to present their health insurance cards when seeking medical treatment so that medical institutions can settle directly with the health insurance department.
All in all, basic medical insurance for urban residents is a social insurance system that provides basic medical protection for urban residents, aiming at solving the problem of urban residents being impoverished due to illness and improving the level of medical protection for residents. Participants are required to pay a certain amount of premiums, enjoy a certain amount of reimbursement of medical expenses, and seek medical treatment at designated medical institutions. The specific implementation details and policies of this insurance system will vary from region to region.
The coverage and reimbursement rates of basic medical insurance for urban residents are formulated and managed by the National Health and Health Commission and the Ministry of Finance and other relevant departments*** together. The scope of coverage includes basic medical services, basic medicines, and basic medical equipment to ensure that urban residents can enjoy the necessary medical protection in the process of seeking medical treatment. The reimbursement ratio refers to the proportion of insurance payment, which is generally set at different rates according to different medical items and drugs. These ratios have been summarized through scientific research and practical experience, aiming at balancing the sustainability of insurance funds and the burden of medical expenses on residents. At the same time, the relevant authorities will make timely adjustments and optimizations in accordance with changes in socio-economic development and medical needs, so as to better meet the medical insurance needs of urban residents.
Legal basis:
The Social Insurance Law of the People's Republic of China:
Chapter III Basic Medical Insurance
Article 26 The standards of treatment of basic medical insurance for employees, new type of rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.