Recently, the Hainan Provincial Medical Security Bureau, the Hainan Provincial Department of Finance, the State Administration of Taxation, the Hainan Provincial Taxation Bureau, and the Hainan Provincial Social Security Service Center jointly issued the "Notice on Clarifying the Relevant Provisions on the Connection of Basic Medical Insurance Benefits" ( Qiong Medical Insurance [2021] No. 335) (hereinafter referred to as the "Notice") will focus on solving problems such as long waiting periods for medical insurance benefits and unprotected benefits during payment interruptions, and achieve seamless connection among various medical insurance benefits. The "Notice" will be implemented from December 1.
Urban employees can be reimbursed retroactively if they stop making payments within 3 months.
"The "Notice" provides insurance coverage for urban employees, urban and rural residents, and key groups. There are detailed regulations on the connection of benefits with the transfer of medical insurance relationships for insured persons. "The relevant person in charge of the Hainan Provincial Social Insurance Service Center said that for urban employees who transfer medical insurance relationships from other provinces to Hainan Province and enjoy normal benefits; Urban employees who have changed their medical insurance relationship and enjoy normal benefits; three types of insured persons who have participated in basic medical insurance for more than 2 consecutive years (inclusive), and whose payment has been interrupted for less than 3 months (inclusive), can be fully insured after paying the insurance premium. They can enjoy the benefits in the amount; they can make up for the medical insurance premiums during the interruption period according to their status as urban employees, and the medical expenses incurred during the interruption period that comply with the medical insurance regulations can be reimbursed retrospectively; those who have interrupted payment for 4 months (inclusive) to 6 months (inclusive) , after continuous insurance participation and payment for 6 months, you can enjoy the full benefits; if you have continuous insurance participation and payment for less than 6 months (inclusive), you can enjoy the benefits according to the current standard of 50% during the period.
Persons who do not meet the above regulations will enjoy benefits according to the following regulations after participating in the insurance and paying the overall fund payment: after paying continuously for 6 months, they can enjoy the benefits in full; if the continuous payment does not reach 6 months ( Including), you will enjoy treatment according to the current standard of 30% during the period. Those who participate in the basic medical insurance for urban employees and receive the monthly payment this month or the following month will be deemed as normal payment.
Urban and rural residents who have been insured for more than 2 years and have stopped paying within 3 months can enjoy full benefits
For those insured as urban and rural residents, basic medical insurance for urban employees can stop paying for 3 months Within months (inclusive), those who participate in the basic medical insurance for urban and rural residents of the current year can fully enjoy the payment benefits of the basic medical insurance for urban and rural residents for that year (including basic medical insurance and critical illness medical insurance, the same below) after participating in the insurance and paying the premium. .
Insured persons who have participated in the basic medical insurance for more than 2 consecutive years (inclusive), and whose payment is interrupted due to the basic medical insurance for urban employees, and participate in the basic medical insurance for urban and rural residents in the current year, will enjoy the treatment of the overall fund payment according to the following provisions : If the payment is interrupted for less than 3 months (inclusive), you can fully enjoy the payment benefits from the Urban and Rural Resident Basic Medical Insurance Co-ordination Fund for the current year after participating in the insurance and paying the premium; if the payment is interrupted for 4 months (inclusive) to 6 months (inclusive), After participating in the insurance and paying the premium, you can enjoy the overall fund payment benefit at the current standard of 50; after 6 months from the date of enrollment and payment, you can fully enjoy the urban and rural residents basic medical insurance unified fund payment benefit for the current year.
Those who do not meet the above regulations or who participate in insurance and pay premiums within non-stipulated time will enjoy the benefits of unified fund payment according to the following regulations: After participating in insurance and paying premiums, they can enjoy the basic pension for urban and rural residents according to the current standard of 30 for that year. Medical insurance unified fund payment benefits; after 6 months from the date of enrollment and payment, you can fully enjoy the current year's urban and rural residents basic medical insurance unified fund payment benefits. If the above-mentioned insured people pay in the first half of the year, they only need to pay the personal payment part; if they pay in the second half of the year, they must pay both the personal payment part and the financial subsidy part.
Those who join the insurance within 90 days after the introduction of talents can enjoy full benefits
For key groups of people who participate in Hainan Province’s urban employee basic medical insurance, they can enjoy full urban employee medical insurance after enrolling and paying. Coordinate fund payment benefits. The key groups are: college and technical secondary school students (including full-time graduate students) who are employed during the period of enjoying urban and rural residents’ medical insurance benefits; landless farmers who are employed while the government pays urban and rural residents’ medical insurance premiums; military personnel who have retired from active service or who are not in the army under the protection of the army. The spouse of an employed military member shall apply for the transfer and continuation of the medical insurance relationship after employment.
Retirees who voluntarily choose to participate in urban and rural residents' medical insurance because they are unable to fully enjoy the urban employee medical insurance benefits will be suspended from the date of suspension of urban employee medical insurance benefits, and employees of state-owned enterprises in difficulty who are unable to pay will be eligible from the date of identification. You can go through the registration procedures for urban and rural residents' medical insurance for the current year within 90 days (including 90 days). After participating in the insurance and paying the premium, you can fully enjoy the payment benefits of the urban and rural residents' basic medical insurance co-ordination fund for the current year.
High-level talents (including foreigners) recognized by Hainan Province and their spouses and children who participate in the basic medical insurance for urban employees can enjoy the full coverage of the basic medical insurance for urban employees after paying the insurance fee. Fund payment benefits. If the spouse, immediate family members and service personnel of the talent who are not employed have not participated in the basic medical insurance outside the province, they can go through the procedures for enrolling in the basic medical insurance for urban and rural residents within 90 days (inclusive) of the date of introduction of the talent. After the insurance is paid, the You can fully enjoy the payment benefits of the unified fund for the current year.
Short-term seasonal workers who have participated in basic medical insurance for two consecutive years (inclusive) can enjoy the medical insurance benefits for urban and rural residents. Those who participate in the basic medical insurance for urban employees during the period can fully enjoy the payment benefits from the basic medical insurance co-ordination fund for urban employees after paying the insurance premium, and the original medical insurance benefits for urban and rural residents will be suspended; if it is less than 2 years, after participating in the insurance and paying the premium, they will be treated as urban employees Employees will enjoy benefits equivalent to 50% of the current payment standard of the basic medical insurance co-ordination fund, and the medical insurance benefits for former urban and rural residents will be suspended. After the insured ends their short-term employment, the original basic medical insurance relationship for urban and rural residents will be restored in a timely manner, and the medical insurance benefits for urban employees will be suspended.
In addition, the "Notice" also stipulates the standards for transfer and continuation of medical insurance relationships for insured persons. After the Urban Employed Medical Insurance is converted into the Urban and Rural Resident Medical Insurance, the deductible payment standard for the current year will no longer be paid in the Urban Employed Medical Insurance. The relevant medical expenses will be accumulated and the annual cumulative maximum payment limit of the Urban and Rural Resident Medical Insurance Coordination Fund will be implemented. After the urban and rural residents' medical insurance is converted into urban employee medical insurance, the minimum payment standard for the current year shall be the urban employee medical insurance minimum payment standard, the relevant medical expenses shall be calculated cumulatively, and the annual cumulative maximum payment limit of the urban employee medical insurance co-ordination fund shall be implemented. The reduced reimbursement ratio of basic medical insurance will not be included in the large medical subsidies for urban employees or the serious illness medical insurance for urban and rural residents.