Suzhou kindergarten points into the medical refers to the urban areas of suzhou (including gusu district, high and new technology district, industrial park, wuzhong district, xiangcheng district) of the floating population, you can apply for the current year in suzhou urban area to participate in the social insurance, and included in the city of the floating population points management, his children in the urban child care institutions and compulsory education stage school enrollment can apply for participation in urban and rural residents medical insurance. Their children are enrolled in nursery institutions and compulsory education schools in the city, and they can apply for urban and rural residents' medical insurance in Suzhou city.
Instructions on the conditions for applying for medical insurance:
1. Childcare institutions and compulsory education schools refer to public and private childcare institutions, elementary school and junior high schools approved by the education administrative departments of Suzhou and the districts.
2. Children of the migrant population who are enrolled in childcare institutions and schools in Suzhou city and who have participated in the medical insurance for residents in Suzhou city do not need to re-apply for points to enter the medical system.
Materials required for the application for medical care:
1. Application form for medical care for children of the floating population in Suzhou city (fill in the application form at the social affairs center of the people's government of the town where you live (street office))
2. Original resident's identity card
3. Original residence card
4. Household registration certificate issued by the public security organ of the household registration area. Public security organs issued by the household registration certificate
5, proof of family relations
6, the applicant's children in the city to enroll in school, school enrollment certificates
7, other required materials
Children points into the medical benefits
Children points into the medical will be able to enjoy the urban and rural residents in the city of suzhou The first thing you need to do is to get a good deal of money to pay for your medical expenses.
Points into the medical process:
1, make an application
Included in the points of management of the floating population, need to be in the city for their children in child care institutions and compulsory education schools, apply for urban and rural residents of Suzhou urban health insurance, should be in June 1 to September 10 each year (except holidays) before the town people's government (street office) to the place of residence to submit a written application, fill out the application form. Submit a written application and fill in the application form.
2. Providing materials
3. Accepting applications
The Social Affairs Center (Citizen Service Center) of the township people's government (street office) will check all kinds of information provided by the applicant, and enter the applicant's information into the "Suzhou Migrant Population Integration Management System" (苏州市流动人口积分管理系统), if the applicant's information is in line with the conditions of the application. "Points into the medical module. After taking photos, the acceptance receipt will be issued.
4, audit scoring
The audit scoring functional departments of the town people's government (street office) application acceptance window to enter the information were audited, the audit did not pass the return of the application acceptance window, the audit passed to make the score and feedback system.
5, published indicators
Municipal human resources and social security departments should be based on the municipal education administration department before September 15 each year identified the number of enrollment targets (including public and private child care institutions and schools) and urban and rural residents of the balance of revenues and expenditures of the health insurance fund, to determine the number of children of the migrant population to participate in urban and rural residents of the next year's health insurance indicators, by the Municipal Migrant Population Integration Management Office The city's Migrant Population Points Management Office shall publicize this to the public.
6, ranking announcement
Municipal Mobile Population Points Management Office, according to the number of children of the mobile population to participate in urban and rural residents in the year health insurance indicators, according to the applicant's points ranked by the municipal human resources and social security departments to confirm, in September each year, uniformly publicized to the community children of the mobile population to enter the list of medical, the publicity period shall not be less than five working days.
7, formalities
The applicant who has obtained the qualification of participating in urban and rural residents' medical insurance should bring the "Approved Form for Children's Admission to Medical Treatment under Points-based Management of the Migrant Population of Suzhou Municipality" and other materials, and then go through the nursery institutions and compulsory schools where their children are enrolled, and apply for the children's admission to medical treatment for the following year within the stipulated period of time between September 1st and November 30th of each year. Anyone who fails to complete the enrollment procedures after the deadline is considered to have automatically given up.
Children's points into the medical how to use
Children's points into the medical to the hospital for medical treatment, you can be reimbursed in proportion to the specific reimbursement rate is as follows:
1, outpatient
In the school (garden) students, children, young people, in urban areas of the fixed-point health care institutions (excluding the fixed-point retail stores) to seek medical treatment
2. Hospitalization
Resident medical insurance participants in designated hospitals in line with the provisions of the medical insurance settlement of hospitalization medical expenses, the implementation of the determination of the starting standard, more than the starting standard portion of the cost of the annual total cost of the accumulated section of the proportional settlement, and hospitalization medical expenses capping method.
(1) The medical expenses within the starting standard of each hospitalization shall be borne by the insured person, and for students and children, the amount shall be 500 yuan.
(2) In the settlement year, after the starting standard is calculated, the rest of the medical expenses incurred by the insured person in each hospitalization will be paid directly into the corresponding payment section according to the actual accumulated medical expenses of inpatient and outpatient specific items of the current year: for the part of the accumulative total of less than 40,000 yuan, the medical insurance fund will pay 75%; for the part of 40,000 yuan to 100,000 yuan, the medical insurance fund will pay 80%; for the part of 100,000 yuan to 200,000 yuan, the medical insurance fund will pay 80%; for the part of 100,000 yuan to 200,000 yuan, the medical insurance fund will pay 80%. For a total of 40,000 yuan, the fund will pay 75%; for 40,000 yuan to 100,000 yuan, the fund will pay 80%; for 100,000 yuan to 200,000 yuan, the fund will pay 90%.
(3) In case of consecutive hospitalization for more than 180 days, the hospitalization will be settled once every 180 days, and the part of the hospitalization that exceeds 180 days will be treated as re-hospitalization.
(4) The accumulated inpatient and outpatient medical expenses of the insured persons in a settlement year shall be capped at 200,000 yuan; the medical insurance fund shall not settle the medical expenses exceeding the capped amount.
3. Outpatient Specific Programs
(1) For uremic dialysis and post-organ transplantation anti-isolate treatment, within the 200,000 yuan limit (including the accumulated inpatient expenses of the current year) for each billing year, the residents' medical insurance fund will settle the expenses at a rate of 90%.
(2) For patients with malignant tumors, the medical expenses incurred for the use of tumor chemotherapy and radiotherapy products, tumor auxiliary products and Chinese herbal medicine tablets during the treatment period (from the date of the registration and confirmation of outpatient specific items for chemotherapy and radiotherapy for malignant tumors to the end of the next settlement year) shall be settled by the residents' medical insurance fund at the rate of 90% per settlement year up to the limit of 200,000 yuan (including the accumulation of the year's inpatient expenses), and the medical expenses incurred for the rehabilitation period (4 settlement years after the end of the treatment period), the medical expenses incurred for the use of oncology auxiliary products and herbal tablets shall be settled by the residents' medical insurance fund at 90% within the limit of 8,000 RMB per settlement year.
(3) Expenses incurred by severely mentally ill patients for the use of therapeutic psychiatric products shall be settled in full by the Residents' Medical Insurance Fund within the limit of 2,000 yuan per settlement year.
(4) Expenses incurred by hemophiliacs for the use of therapeutic substances shall be settled by the Residents' Medical Insurance Fund at a rate of 90% within the limit of 60,000 yuan per settlement year.
(5) Expenses incurred by aplastic anemia patients for the use of therapeutic substances shall be settled by the residents' health insurance fund at a rate of 90% within the limit of 8,000 yuan per settlement year.
(6) Cataract ultrasonic emulsification plus IOL implantation is managed within the limit, of which cataract ultrasonic emulsification IOL implantation cost (including the cost used in addition to the crystal) is limited to RMB 2,500 yuan, and the cost of IOL is limited to RMB 1,000 yuan. When the insured person undergoes cataract ultrasonic emulsification and IOL implantation in the eye clinic of the designated diagnostic and treatment medical institution, the residents' medical insurance fund will settle 90% of the cost within the above cost limit; if the cost is lower than the limit, the medical insurance fund will settle 90% of the actual cost incurred.
4. Special Products
(1) The period of enjoyment of special treatment for the insured is effective from the date of approval of registration, 15 months for Dahina and 12 months for the rest of the products. Each treatment period includes the period of medical insurance payment and gratuitous supply period, which: the use of the provincial provisions of the number of products of the time, classified as the period of medical insurance payment, the corresponding cost of the special by the medical insurance fund and the participants **** the same; according to the provisions of the use of the products of the production enterprises or charitable organizations to provide free of charge to the special time, classified as the period of gratuitous supply, the corresponding cost of the special medical insurance fund and the participants do not have to pay.
(2) The number of specials to be included in the payment of the health insurance fund for each treatment period of the insured person shall be determined according to the diseases he suffers from:
a. HER2-positive breast cancer patients, Herceptin not more than 6 boxes (bottles).
b, chronic myeloid leukemia patients, Gleevec no more than 9 boxes, Dahina no more than 3 boxes, Xinwei or Gernicke no more than 2160 tablets (capsules); of which the sum of Gleevec and Dahina dosage does not exceed 3 months.
c, patients with gastrointestinal mesenchymal stromal tumor, Gleevec no more than 9 boxes, and the dosage does not exceed 3 months.
(3) Special expenses incurred by the insured during the health insurance payment period will be settled by the residents' health insurance coordinating fund at a rate of 70% in accordance with the settlement price of the special health insurance, and the remaining part will be paid by the individual. The amount of the settlement of the special expenses will be counted as the cumulative costs of inpatient and outpatient specific items in the year in which the participant goes through the special expense settlement procedures.
5. Transfer to other hospitals
(1) If a resident health insurance participant suffers from a difficult disease that has not yet been diagnosed by a municipal hospital or a municipal specialized hospital, or if he needs to be hospitalized for a disease that cannot be diagnosed or treated by a municipal hospital or a municipal specialized hospital due to the limitations of its own technology and equipment, he can apply for transfer to other hospitals. After diagnosis by a physician at or above the level of deputy director of the municipal (or specialized) designated hospital, the participant shall fill in the "Registration Form for the Transfer of Participants of Suzhou Municipal Social Health Insurance to Outside Hospitalization", specifying the name of the hospital to which the participant will be transferred for consultation and treatment. The insured person with the above registration form and his/her social security card will go through the registration procedure of transferring to another hospital directly at the hospital's medical insurance department.
(2) The transferring hospitals are limited to local medical insurance designated hospitals above the third level with specialized authority in Shanghai, Nanjing and Beijing; if gamma knife treatment is required due to medical condition, the transferring hospitals are limited to Shanghai PLA 411 Hospital, 455 Hospital, 85 Hospital and Wuxi PLA 101 Hospital.
(3) After completing the registration and filing procedures for transferring to other hospitals, the medical expenses incurred by the insured person for transferring to other hospitals in designated hospitals abroad shall be paid by the individual first, and then he/she shall bring along his/her social security card, the Registration Form for Transferring to Other Hospitals, the original, detailed list of expenses, the discharge summary, and the relevant medical records to the downtown social security agencies for examination and reimbursement in accordance with the regulations in the year after discharge from the hospitals.
6. Out-of-home medical treatment
(1) If a resident health insurance participant lives abroad for a long period of time (more than 60 days), he or she can choose one local health insurance designated community health service center (station) and two local hospitals in the place of residence, and then go to the urban social security administration institution with his or her social security card and the "Out-of-Home Medical Treatment Form for Social Health Insurance Participants in Suzhou", which is stamped and confirmed by the local social security office, and then go to the urban social security administration institution for examination and reimbursement according to the regulations. registration form", go to the social security office in the city to apply for out-of-home medical registration procedures.
(2) After completing the above formalities, the insured person, after paying the medical expenses incurred at the designated medical institution in his/her place of residence in cash, shall bring his/her social security card, the "Registration Form for Overseas Medical Treatment of Social Health Insurance Participants in Suzhou Municipality", the original, detailed list of expenses, the hospital discharge summary, and the medical record data, etc., to the municipal social security office for reimbursement according to the regulations in the billing year.
(3) If an insured person who has completed the procedures for out-of-home medical treatment changes the designated out-of-home medical institution or returns to live in the urban area of the city, he or she should go to the urban social security office to apply for out-of-home change or out-of-home cancellation procedures. Among them, the cancellation of the procedures must be handled only after 60 days of the medical registration procedures, and should be settled in accordance with the provisions of the medical expenses of the expatriate before handling.
7. Auxiliary aids for the disabled
Rehabilitation programs for children with disabilities aged 0-6 years old
Rescue rehabilitation program costs incurred by children with disabilities aged 0-6 years old within the stipulated rehabilitation period shall be settled by the residents' medical insurance fund within the stipulated limit:
(1) Hearing and speech rehabilitation: annual payment limit of 2,400 from the medical insurance fund, and the rehabilitation period shall not exceed 4 years;
(2) Hearing and speech rehabilitation: annual payment limit of 2400 from the medical insurance fund, and the rehabilitation period shall not exceed 4 years. years;
(2) Intellectual Rehabilitation: annual payment limit of 2100 from the medical insurance fund, and the rehabilitation period does not exceed 4 years;
(3) Autism Rehabilitation: annual payment limit of 2700 from the medical insurance fund, and the rehabilitation period does not exceed 4 years;
(4) Physical Rehabilitation (including cerebral palsy): annual payment limit of 2700 (before the age of 3 years);;
(4) Rehabilitation of limbs: annual payment limit of 2700 (before the age of 3 years);;
1350 (after 3 years old),, and the rehabilitation period does not exceed 5 years.