July 1, 2021, the county individual flexible employment personnel to participate in the basic medical insurance of employees officially launched, please qualified personnel enthusiastically for registration, after participating in the insurance, you can enjoy the same health care treatment and employees.
One of the conditions
The age requirement for enrollment. For those who are participating in the individual flexible employment health insurance for the first time, the age of participation should be less than 60 years old for men and less than 55 years old for women.
Requirements for people from outside the city. Individuals from outside the city who are employed on a flexible basis are required to participate in the city's basic pension insurance for employees and make full and timely contributions.
Declaration of major diseases. Individual flexible employment personnel to participate in medical insurance, need to declare major diseases. Those who have suffered from malignant tumors, malignant diseases of the blood system, severe mental illness, organ tissue transplantation, renal insufficiency, cirrhosis of the liver, systemic lupus erythematosus and other major illnesses and have lost most or all of their working capacity are not allowed to participate in the medical insurance for self-employed flexible workers.
Note: Retirees of former bankrupt state-owned and collective enterprises are not subject to the above conditions and can apply for insurance contributions at any time.
Two, reporting materials
The city household registration personnel to provide: the original account book and home page, a copy of my page; original ID card; I copy of the industrial and commercial bank card; recent crownless 2-inch color photo 1.
Outside the city to provide: the original residence permit and a copy of 1; insured myself in Daqing City, a copy of the industrial and commercial bank card; the city's pension insurance statement 1. Recent crown-free 2-inch color photo with white background 1.
Three, the process
Participants with the appropriate declaration materials in the county during the working days from 1 to 20 days a month to the five communities to declare, material review to meet the conditions of participation, participants fill out the "Zhao Yuan County, individual flexibly employed to participate in the health insurance registration form" 2 copies, participants sign the registration form to confirm.
Four, contribution standards
Self-employed flexible workers to participate in the basic medical insurance additional large medical insurance. 2021 annual contribution of 3796.2 yuan, monthly contribution of 316.35 yuan. The annual contribution for major medical insurance premium is 180 yuan, which is deducted from the individual account at the rate of 15 yuan/month.
V. Premium payment
Payment method. Premiums by the county tax bureau commissioned by the Industrial and Commercial Bank of withholding, participants in the end of each month before the end of the deposit of the next month's premiums. Between the 1st and 5th of each month, premiums will be withheld according to the total number of months of accumulated arrears, and those with insufficient balances will not be withheld. For those who are in arrears for less than 6 months, the premiums can be deducted together with the next month's premiums after full deposit. For those who are in arrears for more than 6 months, the system will automatically suspend the insurance, and they need to renew the insurance again before they can continue to collect the premiums.
Adjustment of contribution base. The premium amount is adjusted annually along with the city's average social wage base, participants should pay attention to the end of each year and the beginning of the following year, "Daqing health insurance" WeChat public number of the relevant notices or go to the county's five communities to consult the base adjustments and changes in premiums.
Sixth, health insurance treatment
After the treatment takes effect, the insured person can visit any designated medical institution in Daqing city, district and county, and settle the bill online.
Individual account treatment. Participating in the payment of the next month to start enjoying outpatient personal account treatment, the current amount of personal account transfer in our county is shown in the table below.
Personnel category account monthly credited amount
In-service 84.9 yuan
Retired 84.9 yuan
Outpatient chronic disease, outpatient special treatment treatment. Those who are recognized as eligible are entitled to outpatient chronic diseases and outpatient special treatment. The starting line for outpatient chronic diseases is 600 yuan, and the annual flat-rate reimbursement is carried out according to the type of disease, with a reimbursement rate of 70%. Outpatient special treatment of basic treatment does not set a starting standard, the reimbursement rate of the implementation of inpatient reimbursement rate; auxiliary treatment reimbursement rate of 80%, the annual quota of 10,000 yuan.
Hospitalization treatment. First-time enrollment has a 6-month waiting period for treatment. After 6 months of contributions to enjoy the treatment, the basic medical insurance reimbursement rate of 85% for active, 90% for retirement. The reimbursement rate for large amount insurance is 85%.
Annual reimbursement limits. 100,000 yuan for basic medical care and 200,000 yuan for major medical insurance, for a total annual maximum reimbursement of 300,000 yuan.
Treatment during the period of arrears. Individuals who are in arrears for less than three months will be reimbursed for the medical expenses incurred during the period of arrears; if the arrears are more than three months and less than six months, the medical expenses incurred during the period of arrears can be reimbursed, but the total amount of reimbursement shall not be more than the total amount of the actual contribution; if the arrears are more than six months, the system will automatically handle suspension of the insurance, and medical expenses incurred during the period of suspension shall not be reimbursed, and the renewal of the insurance will be re-established with a six-month waiting period.
VII, health insurance retirement
Contributory years of regulations
Participants in the medical insurance retirement procedures, the cumulative contributory years: men not less than 30 years, women not less than 25 years. Among them, if they are transferred from outside the integrated region, the actual local contribution period shall be not less than 10 years. If the contribution period is insufficient, a lump-sum contribution will be made in accordance with the contribution base at the time of retirement procedures for medical insurance.
The scope of the deemed contribution period and the basis for making up the contributions
The city's local institutions within the scope of co-ordination, Chinese and provincial units, the former municipal state-owned enterprises, collective enterprises and the co-ordination of the region outside the official transfer of the above units, the years of service prior to 1999 can be regarded as the deemed contribution period, 1999 to the time of the retirement procedures for medical insurance is not allowed to interrupt the contributions. During the interruption period, the basis for making supplementary contributions to medical insurance shall be 60% of the average social wage within the co-ordination area in the past years.
Regulation of age at the time of retirement for medical insurance
1. Individuals who have taken part in the basic pension insurance of enterprises in Daqing city and have already applied for old-age retirement can apply for medical insurance retirement formalities with the "Approved Form of Retirement Benefits for Basic Pension Insurance Personnel" when they have reached the age of 60 for men and 50 for women.
2. Individuals who have not participated in enterprise pension insurance can apply for medical insurance retirement procedures when they reach the age of 60 for men and 55 for women.
Declaration materials for medical insurance retirement
1, the former county state-owned collective enterprises for medical insurance retirement to provide: a copy of the old-age retirement approval form and stamped with the official seal of the department and the name of the person in charge of the chapter; my file in Zhao Yuan County, the former Bureau of Labor issued a copy of the registration form of the recruited workers and stamped with the official seal of the department and the name of the person in charge of the chapter; the original household register and the main page, a copy of the person's page 1 copy; original ID card; copy of my industrial and commercial bank card; recent crownless 2-inch color photo with white background.
2, other people for medical insurance retirement provide: original ID card.
Self-declaration
Participants to meet the conditions for health insurance retirement, the need to take the initiative to the county administrative service center health insurance window for retirement procedures, according to the relevant policies and regulations to make up for the shortfall in years of premiums. For those who fail to do so in time, they will still be required to make monthly contributions according to their status as an employee, and the medical insurance department will not notify them separately.
Eight, the transfer of health insurance relations
Cannot repeat the insurance. Participants in the employee health insurance shall not participate in the urban and rural residents basic medical insurance, basic medical insurance treatment shall not be repeated. The year has participated in the urban and rural residents of the medical insurance personnel, transfer to the individual medical insurance, the need to stop the urban residents of the medical insurance for insurance.
The transfer of medical insurance relations. When a participant's work status changes, he or she can transfer from individual to unit, or from unit to individual, or transfer the insurance relationship to outside the city, and the actual contribution years are cumulative.
Nine, the insurance information change
Participants in the industrial and commercial bank card number or cell phone number change, you need to change the procedures in a timely manner. If the change is not made in time, it will affect the medical insurance treatment, and the individual will be responsible for it.
X. Death Cancellation
After the death of a participant, the medical insurance benefits will be terminated and the balance of the individual account can be inherited by the family. Family members should take the "death certificate" to the county administrative service center health insurance window within 7 days to cancel the health insurance relationship. If the medical insurance relationship is not canceled on time, resulting in additional expenditure of the medical insurance fund, in accordance with the relevant provisions of the Social Insurance Law: in addition to the return of fraudulent medical insurance premiums, the fraudulent amount of more than two times five times the amount of the fine, and the circumstances are serious, the transfer of the judicial organs to deal with.
Xi, related business and consulting telephone
Songjiang community: 8210112
Chengbei community: 8239775
Nanyuan community: 8888505
Longyuan community: 8321517
Dongsheng community: 8229556
County Administrative Service Center Medical insurance window: 8333219.
Zhao Yuan County Medical Insurance Bureau
August 2, 2021