The payment standard of children's medical insurance in Dongguan in 2020, the deadline of medical insurance payment in Dongguan in 2020, and the payment grade of medical insurance in Dongguan in 2020.
I. Main contents
The Measures for Social Medical Insurance in Dongguan City integrates the original basic medical insurance regulations, supplementary medical insurance regulations, medical insurance regulations for major diseases and other policy documents and related implementation rules, integrates the past social medical insurance policy framework, payment and treatment standards for various types of insurance and related handling management regulations, and forms a relatively complete document content system from the aspects of policy regulations, management requirements and handling procedures, which is convenient for policy implementation and understanding of regulations.
2. The difference between social medical insurance and social basic medical insurance in Dongguan.
The city implements a multi-level social medical insurance system, including social basic medical insurance (referred to as basic insurance), serious illness medical insurance (referred to as serious illness insurance) and supplementary medical insurance (referred to as supplementary insurance). Supplementary insurance is divided into two parts: inpatient supplementary medical insurance (referred to as supplementary medical insurance) and medical insurance personal account (referred to as medical insurance account).
3. The relationship between basic insurance, serious illness insurance and supplementary insurance.
Basic insurance is the basis of social medical insurance system in our city. Established in accordance with the principles of universal coverage, urban and rural planning, clear responsibilities, moderate security and sustainability. All employees, flexible employees and urban and rural residents in the city participate in basic insurance according to regulations, and participate in serious illness insurance at the same time, and no additional payment is required.
On the basis of participating in the city's basic insurance, the employer and the village (community) can choose to participate in the hospitalization supplement; The employer or village (community) that has participated in the hospitalization supplement can participate in the medical insurance account for all or part of the staff.
Those who have not participated in the basic insurance of this Municipality shall not participate in serious illness insurance or supplementary insurance alone, and those who have not participated in supplementary hospitalization shall not participate in the medical insurance account alone.
Four. Main changes of social medical insurance measures compared with previous policies
(1) insurance payment
1. The overall social basic medical insurance rate is lowered by 0.2%, from 3% to 2.8%.
2. All the non-local household registration children who have participated in the compulsory education and high school in this city for more than 1 year will be included in the scope of participation, and the points admission restriction will be cancelled.
3. Non-registered college students and urban and rural residents have the same insurance payment and enjoy the same treatment and financial subsidies.
4. When the employment of non-local registered personnel who have actually paid insurance premiums in this city for more than 10 years is interrupted, the insurance relationship can be continued by individuals.
5. Urban and rural residents and employees equally implement the payment period policy. After reaching the statutory retirement age and paying the prescribed number of years (that is, 30 years for men and 25 years for women), there is no need to pay. The payment period of insurance for urban and rural residents and the payment period of insurance for employees are calculated together.
6. The payment base of hospitalization supplementary medical insurance is adjusted from the average monthly salary of urban workers to the average monthly salary of employees in the city, which is unified with the basic medical insurance base to reduce the payment burden of the insured.
(2) Adjustment of treatment
1. Simplify the segmentation of the maximum compensation limit, and pay from the condition of enjoying the maximum compensation limit in continuous insurance.
The level of basic medical insurance and serious illness insurance for urban and rural residents in Dongguan will continue to improve. Yesterday, Dongguan Medical Insurance System Work Conference was held. Zou Lian, director of Dongguan Medical Security Bureau, said at the meeting that this year, efforts will be made to solve the problem of unbalanced and insufficient development and weave a "healthy network" for the majority of insured people. It is reported that on the basis of raising the financial subsidy standard for medical insurance for urban and rural residents at all levels last year, Dongguan will increase the financial subsidy for 30 yuan per capita this year, of which 15 yuan will be used for medical insurance for serious illness.
Give the poor a reasonable "second aid".
The reporter learned from the meeting that in terms of medical procurement and service management, which citizens are concerned about, Dongguan will continue to improve the payment by disease score, further enrich the database of disease score with Wei Jian and the financial department, and strive to improve the standardized and accurate management service level of medical insurance. According to reports, Dongguan will learn from the settlement experience of Shenzhen Luohu Medical Association, formulate supporting measures for medical insurance settlement of close medical associations, improve the settlement methods for high-tech and key projects, and build an "all-round" medical insurance system with Dongguan characteristics.
This year, in terms of medical assistance for needy groups, Dongguan will implement "secondary assistance" for serious and serious diseases of needy families, and give full play to the role of medical security in poverty alleviation. For the poor people who are reimbursed for basic medical insurance, serious illness insurance and medical assistance, the total medical expenses borne by individuals are still too heavy, which affects their basic livelihood, and reasonable "second assistance" is given. At the same time, Dongguan continued to improve the basic medical insurance and serious illness insurance for urban and rural residents. Last year, Dongguan raised the financial subsidy standard of medical insurance for urban and rural residents at all levels, and added 40 yuan per capita, half of which was used for serious illness insurance. On this basis, this year, the per capita financial subsidy for 30 yuan will be increased, of which 15 yuan will be used for serious illness medical insurance, further reducing the medical burden of seriously ill patients and people in need.
Zou Lian emphasized that Dongguan will focus on cracking down on insurance fraud this year, and a series of publicity and law enforcement inspection activities will be launched in April. In addition, the medical insurance department in Dongguan will comprehensively promote the legalization and informatization construction of medical insurance, strengthen the targeted research of provincial-level overall planning of medical insurance, make preparations for the implementation of the merger of maternity and medical insurance, and do a good job in personnel training.
72 designated hospitals 100% connected to the national platform.
In 2065438+2008, the total number of medical and maternity insurance participants in Dongguan exceeded the indicators issued by the province, reaching 580 1.400 and 4,730,900 respectively; New breakthroughs have been made in direct settlement of medical treatment across provinces and different places. 72 designated hospitals in the city 100% access to the national platform, realizing the direct settlement of medical treatment for insured persons in different places in 455 regions of the country. In addition, relying on the Shenzhen platform to implement centralized drug procurement has achieved new results, with a comprehensive fee reduction of 18.59%, saving 396 million yuan in the whole year.
In the past two years, Dongguan has investigated and dealt with 2 cases of medical insurance fraud (including work-related injuries), and recovered 295 1 10,000 yuan, of which 6 cases were transferred to public security organs and sentenced to 1 person. Since the beginning of this year, four cases of medical insurance fraud have been investigated and dealt with, and 3,200 yuan of funds have been recovered.
20 18
Dongguan has raised the financial subsidy standard of medical insurance for urban and rural residents at all levels, and added 40 yuan per capita, half of which is used for serious illness insurance.
April 20 19
The financial subsidy standard for medical insurance for urban and rural residents in Dongguan increased the per capita 30 yuan, of which 15 yuan was used for medical insurance for serious illness.
According to the regulations, the conditions for those who go through retirement formalities before the implementation of the New Deal in June 5438+ 10/shall be subject to the original regulations.
After the implementation of the New Deal, the conditions for retirees to enjoy medical insurance benefits are adjusted as follows: the minimum payment period for male employees is 25 years, and the minimum payment period for female employees is 20 years, of which the actual payment period should be at least 10 year.
If the minimum payment period is not up to the above standards, the employer can enjoy the medical insurance benefits for employees after making up the medical insurance premiums for employees with poor years at one time. The payment base is the salary declared in the year when I retired, and the payment ratio is 5.6%. All overdue fees will enter the overall fund and will not be included in the personal account.
According to the policy, if the employer fails to pay the employee's medical insurance premium in full and on time after participating in the employee's medical insurance, the incumbent will suspend the employee's medical insurance benefits; Retirees who have met the conditions for enjoying medical insurance benefits for retirees will continue to enjoy medical insurance benefits for employees.
If an employer who has participated in employee medical insurance has no employees on the job or is bankrupt, dissolved, revoked or cancelled, the employer will no longer pay the medical insurance premium of 10 year for retirees who have already enjoyed medical insurance benefits, and their retirees will continue to enjoy medical insurance benefits for employees. According to the current policy, those who go through the retirement formalities of endowment insurance in the company are not limited by the number of years after retirement, but after retirement, the company still has to bear the serious illness relief expenses of 15 yuan.
How many years does medical insurance have to be paid? What is the payment ratio? For how many years should medical insurance be paid, medical insurance is mainly divided into employee medical insurance and urban and rural residents' medical insurance, and the annual payment amount of different types of insurance is different.
1, elderly people over 70 years old: 4,300 yuan per person per year, of which individuals pay 370 yuan;
2. Persons aged 60-69: 4,300 yuan per person per year, of which 535 yuan is paid by individuals;
3. 19-59 years old: 2,900 yuan per person per year, of which individuals pay 720 yuan;
4. Children: RMB 1 100 per person per year, of which 1 10 yuan is paid by individuals.
For example, at present, the contribution rate of social basic medical insurance for employees in Dongguan is 1.8%, and the individual contribution rate is 0.5%. The employer 1 1%, and the individual pays 2%.