District medical insurance, basic medical insurance treatment (a) the source of funds for personal account 1, the basic medical insurance premiums paid by the individual employee's own 2% of his or her gross salary into the personal account. 2, the employer's basic medical insurance premiums paid by the employer's total wages of 8% (6% in 2002), according to the provisions of the part of the transfer into the personal account, the specific allocation of the law is 45 years of age and below 0.5%; 46 years of age and above 59 years of age 1%; 60 years of age and above 1.5%. The specific method of allocation is 0.5% for those aged 45 and below; 1% for those aged 46 to 59; and 1.5% for those aged 60 and above. (b) The source of the integrated fund is the basic medical insurance premiums paid by the employer, and the rest goes into the basic medical insurance integrated fund, in addition to the prescribed portion that goes into the individual account. (iii) Scope of payment of the individual account The individual account is mainly used to pay for outpatient medical expenses in accordance with the basic medical insurance drug catalog and diagnostic and treatment items; to pay for inpatient medical expenses to be paid by the individual; and to pay for the expenses of special examinations and special treatments as well as some outpatient medical expenses for outpatient chronic disease patients. (D) the scope of payment of the integrated fund 1, hospitalization medical expenses: hospitalization medical expenses incurred in accordance with the provisions of the basic medical insurance: above the starting standard, below the maximum payment limit by the integrated fund to pay the majority of the cumulative approach in accordance with the segment, the individual also has to pay a certain percentage of the: the integrated fund to pay the proportion of the individual to pay the proportion of the hospitalization medical expenses in the work of the retired in the working retirement of more than the starting amount to 5000 yuan 707520155000-10000 yuan 7580151010000 yuan to the maximum limit of 80851052, a year of the integrated fund of the maximum payment limit for the employee's annual salary 4 times, exceeding the maximum limit of the medical expenses, the integrated fund will no longer pay. Participants pay in cash and through commercial medical insurance and other means. Provisional Provisions on Medical Benefits for National Civil Servants (1) Scope of Benefits 1) Medical expenses and drug catalogs in accordance with the standards for diagnostic and treatment items and medical service facilities of the basic medical insurance 2) Part of the medical expenses exceeding the maximum payment limit of the basic medical insurance fund 3) Individuals' out-of-pocket medical expenses exceeding a certain amount within the scope of the payment limit of the basic medical insurance 4) Medical expenses incurred by medical caregivers in accordance with the provisions of the medical care. Medical expenses incurred by medical care personnel who are entitled to medical care according to the regulations. 5. Work-related injuries and birth medical expenses that are eligible for medical benefits for national civil servants. 6. Maternity medical expenses. (ii) Outpatient medical subsidies in accordance with the provisions of the basic medical insurance, the occurrence of a medical expense: 55% of the subsidy for active employees (outpatient medical expenses exceeding a total of more than 1,600 yuan within a year) will no longer be subsidized. Retirees are subsidized 65% (outpatient medical expenses totaling more than 1,800 yuan within one year). 90% of the subsidy for medical care personnel (total outpatient medical expenses exceeding RMB 2,000 or more within one year) will no longer be subsidized. (iii) Hospitalization subsidy 1. Hospitalization bed fee subsidy: for the part of the bed fee exceeding RMB 15 yuan of basic medical insurance, the daily subsidy is RMB 10 yuan for the active staff, RMB 15 yuan for the retired staff, and RMB 25 yuan for the medical care staff.2. The part of the medical expenses incurred for hospitalization in one year that are borne by the individual above the starting standard and below the maximum payment limit of the basic medical insurance co-ordination fund, such as Class B drugs, Class B materials, Class B diagnostic and therapeutic materials, and Class B diagnostic and therapeutic materials, is no longer subsidized, The subsidy for the part of medical expenses incurred in hospitalization within one year above the starting payment standard and below the maximum payment limit of the Basic Medical Insurance Coordination Fund that is borne by individuals, such as Class B drugs, Class B materials, Class B diagnostic and therapeutic items, and the segmented cumulative out-of-pocket part of the expenses, is 85% for the active staff, 90% for the retired staff, 95% for the medical care staff, and 100% for the health care recipients.3 The subsidy for the use of the medicines other than those listed in the Basic Medical Insurance Drug List in the event of a critical condition for the rescue of a hospitalized patient is 50% for the active staff, 60% for the retired staff and 90% for the medical care staff. The subsidy is 90% for medical care workers. The method of this subsidy is that the doctor fills in the application form, reports to the medical insurance center for approval and then settles the bill in cash, and then goes to the medical insurance center for reimbursement in accordance with the regulations with the hospitalization invoice and the application consent form. Part of the outpatient chronic disease medical treatment 1, the outpatient chronic disease included in the disease: coronary heart disease, diabetes mellitus, various malignant tumors, chronic obstructive pulmonary emphysema, hypertension, Parkinson's syndrome, cirrhosis of the liver in the stage of loss of compensation, uremia, chronic heart failure, organ transplantation, anti-rejection of the immune modulation of the treatment. 2, each participant can declare a maximum of three types of disease. 3, the outpatient chronic disease in accordance with the provisions of the only entitle the Chronic diseases are only entitled to the medicines in the Medicare Drug List of the prescribed scope of chronic diseases. 4. Before entering into the chronic disease subsidy, the individual shall pay for the medicines below the starting standard, i.e. 8% of the employee's annual average gross salary, and the rest of the medicines will be paid proportionally into the coordinated fund. Fourth, the payment ratio of the special inspection and special treatment program 1, according to the provisions of the part of the special inspection and special treatment first by the individual to pay 40% of the cost of the remaining costs of the basic medical insurance to pay the proportion of the individual to pay part of the subsidy according to the proportion of civil servants and the limit of the subsidy. 2, the use of imported materials first by the individual to pay 50% of the proportion of the cash, and the rest of the cost of the subsidy in accordance with the provisions of Article 1. V, in the region directly in the Yong organs and institutions employees (public) injury medical treatment according to the spirit of GuiLaoShe medical insurance (2002) No. 9 documents: 1, in the region directly in the Yong organs and institutions in line with the enjoyment of the national civil service medical subsidies for the employees, the occurrence of the provisions of the work (public) injury medical expenses in the national civil service medical subsidies for the reimbursement of the funds. 2, in the region directly in the Yong organs and institutions in the event of industrial (public) injury employees Accidents must be reported by telephone within 48 hours of the District Labor Office of the Medical Insurance Office, and within 15 days to fill out (in the regional units in Yong employees work (public) injury accident report form in triplicate, by the autonomous region of the Department of Labor and Social Security administrative departments recognized as a work-related injuries to employees, in accordance with the provisions of the enjoyment of the medical treatment of work-related (public) injuries. 3, the employer and the injured employee must provide the following proof of work (public) injury accident report form, a designated hospital diagnostic statement or Occupational disease diagnosis certificate, the relevant inquiry transcripts and circumstantial materials; traffic accidents, to provide the traffic police department to deal with the accident liability determination certificate and other materials. 4, the central and regional institutions in Yong organs and institutions after the occurrence of work (public) injury accident, the current designated hospital is set up as the first hospital of the Guangxi Medical University (including the second hospital that is the West Hospital). Guangxi District People's Hospital, Guangxi Workers' Hospital, Nanning Second People's Hospital. The critically injured can be rescued in the nearest hospital, and then transferred to the designated hospital for further treatment after the injury is stabilized.5. During the period of medical treatment for the workers injured at work (public), the basic medical insurance for urban workers of Guangxi Zhuang Autonomous Region will be implemented with the items of diagnosis and treatment, the scope of medical service facilities and the standard of payment, and the directory of medicines for basic medical insurance of Guangxi District. During the rescue period, the scope of medicines required can be appropriately relaxed, but it must be declared to the Social Security Bureau of the Autonomous Region for approval.6. During the treatment of work-related injuries, the hospitalization medical expenses in accordance with the relevant provisions of the basic medical insurance shall be fully reimbursed in the medical subsidy for national civil servants.7. The expenses incurred by the employees who are recognized to be work-related injuries in outpatient clinics and hospitalization shall be firstly advanced by the unit in cash, and later on, with the approval form of the work-related injuries, the medical insurance certificate, the list of medical expenses and so on, and the hospital certificate, Hospital certificate, list of medical expenses, etc. to the Social Security Bureau of the Autonomous Region to apply for review and reimbursement. VI. Management of individual medical insurance IC card 1. Individual medical insurance IC card records the medical insurance file information of the insured person, the individual account funds and the use of the status of the use of personal custody by the use of the individual. 2. Individual account principal and interest belong to the individual, in principle, may not be withdrawn from the cash. 3. Loss of or damage to the IC card, the loss of the card with the personal identification card to the regional medical insurance center, the loss of a moment can not be processed for the loss of the person, you can call the regional medical insurance center to notify the loss of the lost in advance. Notify the district medical insurance center of the loss, so as to avoid unnecessary losses, lost telephone 2853836. municipal health insurance, a specific outpatient program of medical treatment 1, the scope of the specific program is: malignant tumors radiotherapy, dialysis treatment of uremia, organ transplantation, anti-rejection treatment. 2, in line with the specific program of the insured person, each time you visit the doctor to submit a written application for approval of the formalities incurred after the cost of the individual employee 15%. The insured person who meets the specific items shall apply in writing by the doctor at each visit, and the expenses incurred after the approval procedure shall be borne by 15% for the active person, 8% for the retired person, and the rest of the expenses shall be paid by the integrated fund.3. The insured person who is aged over 50 and suffers from a serious chronic disease with a cumulative cost of more than 500 yuan of medicines for outpatient treatment within 30 days shall fill in a reimbursement form for the medicines with an invoice of the medicines for outpatient treatment and a medical record to the Municipal Medical Insurance Center and then be reimbursed according to the regulations. The management and payment of special examination and treatment 1. For the special examination and treatment projects approved by the application, the active staff will pay 30% out of their own pocket; the retired staff will pay 15% out of their own pocket. 2. For in-patients, the costs of imported artificial organs and materials placed inside the body, which are approved for use due to their medical conditions, will first be paid by the individuals in cash, and then reimbursed to the Municipal Health Insurance Center in accordance with the regulations after submitting the other relevant information. Medical Mutual Aid Payment Treatment 1. If an employee who participates in Medical Mutual Aid pays more than the maximum limit of the integrated fund, the excess medical expenses will be paid in cash and reimbursed from the Medical Mutual Aid in accordance with the regulations at the Municipal Medical Insurance Center with a ticket. 2. The maximum limit of the integrated fund payment is 4 times of the previous year's average gross salary of the employee. 3. The hospitalization expenses incurred in the first half year of the average salary of the employee in the integrated area will be less than 9 times (including 9 times) of the average salary of the employee. 4. If the hospitalization expenses are less than 9 times the average salary of employees in the first half of the year in the coordinated area (including 9 times), the medical mutual fund will pay 70% and the individual will pay 30%; if the average salary is more than 9 times and less than 13 times (including 13 times), the medical mutual fund will pay 80% and the individual will pay 20%; if the average salary is more than 13 times and up to 15 times, the medical mutual fund will pay 90% and the individual will pay 10%. The scope of treatment items that are not paid by basic medical insurance is divided into the following categories. Service items: 1) registration fee, out-of-hospital consultation fee, consultation fee, expedited examination and treatment fee, surcharge for surgery by name, and special medical service for self-employed nurses; 2) all kinds of cosmetic, fitness and non-functional cosmetic and orthopedic surgeries; 3) all kinds of weight-loss, weight-gaining, and height-gaining programs; 4) all kinds of health checkups and medical appraisal fees. II. Diagnostic and therapeutic equipment and medical materials 1. Applied Electron Emission Tomography (PET), ophthalmic excimer laser treatment. 2. Eyeglasses, dentures, prosthetic eyes, hearing aids. 3. A variety of self-use of health care, massage, examination and treatment of instruments. III. Treatment items 1. Organ or tissue source of various types of organ or tissue transplants. 2. In addition to kidney, heart, cornea, skin, blood vessels, bone, bone marrow transplants, other organs or tissue transplants. 3. Orthopaedic myopia. 4. Qigong, music therapy, spectrum therapy, laser therapy, photo-quantum therapy. 5. All kinds of infertility (pregnancy), sexual dysfunction of the diagnostic and treatment programs, sexually transmitted infections, the cost of examinations and treatments. IV. Life service items 1. Consultation and referral transportation fees, emergency vehicle fees. 2. Hospital air-conditioning fees, escort fees, nursing fees. 3. Expensive special services. V. Other Others 1) Medical expenses incurred when not attending the designated medical institutions (except for rescue) 2) Expenses incurred when going abroad for medical treatment without the approval of the relevant departments 3) Medical expenses incurred in foreign countries, Hong Kong, Macao and Taiwan 4) Medical expenses incurred by female workers in childbirth (reimbursed separately according to the relevant policies on childbirth) 5) Expenses incurred in accidents caused by work (public) injuries (reimbursed separately according to the relevant regulations on work injuries) 6) Expenses incurred in traffic accidents, medical accidents, suicides, and other accidents (including those caused by the death of an employee or the death of an employee) Traffic accidents, medical accidents, suicide, self-inflicted injuries, alcoholism, fights and brawls. 7. Dental scaling, dental insertion, assembly of prosthetic eyes and limbs. 8. Expenses for medicines other than those listed in the drug catalog of the Guangxi Zhuang Autonomous Region's basic medical insurance. 9. Homemade medicines, self-defined items and new checkups and treatments that are not approved by the authorities in charge of health, drug supervision and management, price and the district social security bureau. After paying the medical insurance, as long as the hospitalization meets the starting standard, it can be reimbursed, and the average reimbursement can reach more than 80%. In accordance with national regulations, the starting standard of hospitalization medical fees paid by the social insurance fund is determined by about 10% of the average salary of local employees. The city's original provisions of the first, second and third-level medical institutions for the previous year, respectively, 6%, 8%, 10% of the average salary of employees, with the average salary of employees year by year, should be adjusted annually. However, taking into account not to increase the burden on employees, the city has been calculated in accordance with the 2000 social wage standard implementation, did not adjust with the increase in social wage, the starting standard were 500 yuan, 670 yuan, 840 yuan. From the viewpoint of reducing the burden on employees, this revision will decouple the starting standard from the average salary of employees, and the first, second and third-level medical institutions will still maintain the current standard: 500 yuan, 670 yuan and 840 yuan, and will be adjusted appropriately according to the income of employees and the income and expenditure of the health insurance fund. In a medical year, the first hospitalization, the starting standard by 100%, the second hospitalization, the starting standard by 50%, the third and above hospitalization, no longer set the starting standard
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