When do urban residents pay for basic medical insurance?
Basic medical insurance for urban residents takes the natural year as the insurance year. The insured residents pay medical insurance premiums according to the natural year, and the payment period is from October 1 to November 30 every year.
For the convenience of the insured residents to pay the premiums and the management of the insurance, at the beginning of the basic medical insurance for urban residents, i.e., from October 1, 2007 to December 31, 2008 for one insurance year, the insured residents should pay the medical insurance premiums in full and in one time for 15 months.
Honghe Prefecture to participate in the urban residents of the basic medical insurance knowledge answers
A, urban residents of the basic medical insurance scope and objects are which?
(1) All non-working urban residents, students, children and teenagers (including children of migrant workers who go to school and live in the city with their parents) who are not covered by the basic medical insurance for urban workers and the new type of rural cooperative medical care within the administrative area of the Prefecture can participate in the basic medical insurance for urban residents in the way of their units (schools, gardens and institutes), their families or individually in accordance with the regulations.
(2) Children of migrant workers who have not participated in the New Rural Cooperative Medical Scheme (NRCM) (and who have been living with their parents for more than three years, subject to the time of registration at the local police station) may participate in the basic medical insurance for urban residents.
(3) All and most of the landless rural residents can choose to participate in the basic medical insurance for urban residents on the basis of certificates issued by the villagers' committees. Most of the landless rural residents refer to those who have lost their land and whose per capita area of existing cultivated land is less than 0.3 mu (including 0.3 mu) or less.
(d) Other persons who are covered by the basic medical insurance for urban workers and the new type of rural cooperative medical care shall no longer participate in the basic medical insurance for urban residents.
Second, how to participate in the basic medical insurance for urban residents?
(a) the domicile of the school (garden, school) in the county or city, by the school (garden, school) unified organization to fill out the "Honghe Prefecture urban residents of the basic medical insurance application registration form" and "Honghe Prefecture urban residents of the basic medical insurance details of the participants", by the local health care insurance agency audit and confirmation of the insurance procedures and issued a confirmation of the participation in the payment of fees notice.
(2) If the household registration does not belong to the county or city where the school (garden or institute) is located, hold a certificate from the school and go back to the county or city where the household registration is located to go through the registration procedures according to the following provisions.
(3) Other urban residents? (including minors who are not in schools, gardens or schools) to participate in the basic medical insurance for urban residents, go to the townships, streets and communities where their household registration is located to fill in the "Application for Registration of Basic Medical Insurance for Urban Residents in Honghe Prefecture" and go through the registration formalities for participation in the insurance. After the local medical insurance agency verifies and confirms the identity, it will issue a notice of confirmation of participation and payment of fees.
Three: What kind of documents do I need to provide when applying for the insurance?
Urban residents (including students and children) need to bring their household registers, ID cards, and a recent five-point color photo. The following people are also required to provide equivalent supporting documents for enrollment:
(a) For urban low-income insurance recipients, they are required to provide the Certificate of Receipt of Minimum Subsistence Guarantee for Urban Residents.
(2) For severely disabled people who have lost their ability to work, they need to provide the Certificate of Disabled Persons of the People's Republic of China*** and the People's Republic of China.
(iii) For low-income families with elderly people over 60 years old, they need to provide a certificate from the social security department that they have not received pension insurance benefits.
Four: What is the contribution standard for basic medical insurance premiums for urban residents?
(a) Students, children and teenagers each pay 0.6% of the statewide average social wage for the previous year per person per year, and the financing standard is not less than 100 yuan.
(2) Other non-working urban residents will each contribute 1.3% of the previous year's statewide average social wage per person per year, with a funding standard of no less than 220 yuan.
V. What are the standards for family and individual contributions and government subsidies?
(A) special groups of adults (urban low-income recipients, the loss of working capacity of the severely disabled, low-income families over 60 years of age): the full amount of financial subsidies, individuals do not contribute.
(2) Other residents among adults: 150 yuan in financial subsidies and 70 yuan in individual contributions.
(3) Students in primary and secondary schools, vocational high schools, junior colleges, technical schools, and children and teenagers: 90 yuan in financial subsidies and 10 yuan in individual contributions.
(4) Students in primary and secondary schools, vocational high schools, junior colleges, middle schools, technical schools, and children and youths who are low-income recipients or have severe disabilities: the full amount is subsidized by the treasury, and individuals don't pay the fee.
(v) Full-time college students: those who were originally entitled to publicly-funded medical care are fully subsidized by the treasury, and individuals do not contribute; those who are not entitled to publicly-funded medical care pay 10 yuan per person per year, and the rest are subsidized by the treasury.
Sixth, the basic medical insurance for urban residents when to pay?
The basic medical insurance for urban residents takes the natural year as the insurance year. The insured residents pay medical insurance premiums according to the natural year, and the payment time is from October 1 to November 30 every year.
For the convenience of the insured residents' payment and management of the insurance, at the beginning of the urban residents' basic medical insurance, i.e., from October 1, 2007 to December 31, 2008, which is an insurance year, the insured residents should pay the medical insurance premiums in full and in one go for a period of 15 months.
VII. How are the individual and family contributions to urban residents' basic medical insurance collected?
(1) For students and children who are enrolled in the unified organization of schools (gardens and institutes), the schools (gardens and institutes) will collect the premiums from students and children within five working days after the payment is confirmed by the local county and municipal medical insurance agencies with the payment notices issued by the schools and institutes and then pay them into the designated banks within five working days, which will then issue receipts for the social insurance premiums.
(2) For other insured residents, the individual or family shall make a one-time full payment at a designated bank branch within the specified payment period with the notice of confirmation of participation and payment issued by the medical insurance agency of the county or city of the place of participation, and the designated bank shall issue a receipt for the social insurance premiums.
(3) In townships where the designated bank has no outlets, the institutions entrusted by the bank will collect the contributions.
How are the basic medical insurance cards and social security cards for urban residents issued?
(1) Schools (gardens and institutes) that uniformly organize students and children to participate in the insurance, with the receipts for social insurance premiums issued by the designated bank, go to the local medical insurance agency to receive the medical insurance card and social security card, which will be issued to the students and children themselves.
(2) Other insured residents, with the receipt of social insurance premiums issued by the designated bank, go to the street or community where they are registered to receive the medical insurance card and social security card.
(3) Loss or replacement of the medical insurance card and social security card shall be handled by the insured resident or his/her delegate at the medical insurance office in the place where he/she is insured.
Nine, the insured residents did not apply for the renewal of the next year as required, interrupted the payment of medical insurance premiums, can continue to enjoy the relevant benefits?
The insured residents should go through the renewal procedures for the next year before November 30 of the current year and pay the medical insurance premiums for the next year. Latecomers will not be entitled to the next year's urban residents' basic medical insurance premium subsidy. Those who do not renew their insurance on a yearly basis and have interrupted their contributions for more than one year are required to pay the full amount of medical insurance premiums for the interrupted year before they can renew their insurance.
Ten, the insured residents in the state within the scope of the transfer of domicile, the individual social security card, medical insurance card can continue to use?
You can continue to use them. However, the insured residents should go to the medical insurance office of the place where they move out of their domicile to issue a transfer order for the medical insurance relationship, and then go to the medical insurance office of the place where they move in to apply for change procedures.
Xi. Under what circumstances will the basic medical insurance relationship of urban residents be terminated during the year of participation?
(1) If a participant's household registration is moved from the state to a place outside the state, the basic medical insurance relationship and benefits for urban residents will be terminated at the end of the current participation year.
(2) In the event of the death of a resident, his/her family members or a delegate will take the death certificate and his/her social security card and medical insurance card to the medical insurance agency for cancellation and termination of the medical insurance relationship. If the medical expenses have not yet been settled, they should be handled in a timely manner, and then go through the cancelation procedures and terminate the medical insurance relationship.
(3) If they are recruited by state organs, institutions, enterprises and other employers, the basic medical insurance relationship of urban residents shall be terminated, and they shall be transferred to the basic medical insurance of urban workers.
(4) If an insured resident is sentenced to imprisonment, the medical insurance relationship will be suspended, and the paid medical insurance premiums will not be refunded.
Twelve, has participated in the urban residents of the basic medical insurance, with the conditions to participate in the basic medical insurance of urban workers, can be transferred to the basic medical insurance of urban workers?
Urban residents who have the ability to work during their working age should be employed in a variety of ways and participate in the basic medical insurance for urban workers. Residents who have already participated in the basic medical insurance for urban residents and have the conditions to participate in the basic medical insurance for urban workers may be transferred to the basic medical insurance for urban workers, and their years of contribution to the basic medical insurance for urban residents shall no longer be subject to the start-up payment for the basic medical insurance for urban workers.
Thirteen: When do the participating residents start to enjoy medical treatment?
Participating residents, after paying the full amount of medical insurance premiums within the stipulated time, start enjoying the medical treatment of urban residents' basic medical insurance for outpatient major illnesses and hospitalization from the month following the payment. Failure to pay the contributions in full and on time or interruption of payment will result in the cessation of enjoyment of basic medical insurance benefits for urban residents.
Fourteenth: At present, what kinds of outpatient major diseases are recognized by the basic medical insurance for urban residents? How are their outpatient expenses reimbursed?
There are three kinds of malignant tumors, dialysis for chronic renal failure and anti-rejection after kidney transplantation. After applying to and being approved by the medical insurance agency, the medical expenses of their outpatient treatment can be included in the medical insurance fund as the provisions of hospitalization treatment.
Fifteen: What are the starting standard, maximum payment limit and individual out-of-pocket ratio for hospitalization under the basic medical insurance for urban residents?
(1) The starting standard for hospitalization is 600 yuan for designated medical institutions outside the state; 500 yuan for designated medical institutions of the first category, 300 yuan for designated medical institutions of the second category, and 100 yuan for designated medical institutions of the third category in the state.
The hospitalization starting standard is halved for special groups of insured residents (urban low-income recipients, severely disabled persons with incapacity for work, and elderly persons over 60 years of age in low-income families) as well as for urban low-income recipients and severely disabled persons among students and children.
(2) The maximum payment limit of the Basic Medical Insurance Fund for Urban Residents in Honghe Prefecture is 16,000 yuan per person per year.
(3) For medical expenses above the starting payment standard and below the maximum payment limit which are in line with the provisions of the basic medical insurance for urban residents, the proportion of individual out-of-pocket payment shall be as follows: 50% for designated medical institutions outside of the state; 45% for designated medical institutions of the first category, 35% for designated medical institutions of the second category, and 20% for designated medical institutions of the third category within the state.
16. What is the payment standard for general hospital bed fee?
It is 12 yuan per person per day for a class I designated medical institution, 8 yuan per person per day for a class II designated medical institution, and 6 yuan per person per day for a class III designated medical institution. Other inpatient bed fees are paid at a rate no higher than RMB 30 per person per day. If the actual bed fee is lower than the payment standard, the actual bed fee will be settled and paid according to the regulations; if it is higher than the payment standard, the payment standard will be settled and paid according to the regulations, and the excess will be borne by the individual.
Seventeen: How to pay for the costs of Class A and B drugs within the scope of urban residents' basic medical insurance?
(1) The cost of Class A drugs shall be paid from the basic medical insurance fund for urban residents in accordance with the regulations.
(2) For the cost of Class B drugs, individuals pay 10% of the cost out of their own pockets, and the remaining 90% of the cost is paid out of the basic medical insurance fund for urban residents in accordance with the regulations.
(3) For expenses incurred for the use of restricted medicines within the scope of rescue, the individual first pays 20% out of pocket, and the remaining 80% is paid out of the basic medical insurance fund for urban residents in accordance with the regulations.
Eighteen, the scope of special examination, special treatment, special medical materials and artificial organs, as well as the application and approval procedures and payment ratio, according to what regulations?
In accordance with the relevant provisions of the basic medical insurance for urban workers.
Nineteen, how to actively renew the insurance for the insured residents, and how the number of years of contributions is linked to the enjoyment of benefits?
Participating residents in the growth of the number of years of fees to enjoy the treatment of reducing the proportion of individual out-of-pocket payments, the reduction of out-of-pocket payments on the premise of continuous payment, according to the payment of every three years to reduce 1 percentage point, down to 5 percentage points until.
Continuous contributions for more than 3 years (including 3 years) less than 6 years, the individual out-of-pocket ratio reduced by 1 percentage point; continuous contributions for more than 6 years (including 6 years) less than 9 years, the individual out-of-pocket ratio reduced by 2 percentage points, continuous contributions for more than 9 years (including 9 years) less than 12 years, the individual out-of-pocket ratio reduced by 3 percentage points; continuous contributions for more than 12 years (including 12 years) less than 15 years (including 15 years) more than 15 years, the individual out-of-pocket ratio reduced by 1 percentage point. 15 years) or more, the individual out-of-pocket ratio is reduced by 5 percentage points.
In case of interruption of contributions, the years of contributions in advance of the interruption will no longer be counted as years of continuous contributions.
Twentieth, students, children in the accidental injury, medical expenses can be reimbursed by the urban residents of the basic medical insurance?
Students and children who are not responsible for the accidental injuries incurred can have their hospitalization medical expenses incurred in the designated medical institutions included in the scope of the urban residents' basic medical insurance fund and be paid out of the urban residents' basic medical insurance fund on the basis of the hospitalization medical expenses incurred in the designated medical institutions, the diagnostic certificates of the designated medical institutions, and the relevant certificates and documents issued by the schools.
Twenty-one: What are the behaviors of the insured residents that are not allowed to enjoy the basic medical insurance treatment for urban residents and what are the expenses that are not paid by the basic medical insurance fund for urban residents?
(1) Participants shall not be entitled to basic medical insurance for urban residents under any of the following circumstances:
1. Failure to seek medical treatment at a designated medical institution (except for emergencies), transferring to another hospital without authorization, and other acts of medical treatment that do not comply with the provisions of the basic medical insurance for urban residents.
2. Suicide, self-injury, crime, assault and battery, alcoholism, drug addiction and other personal misbehavior occurring in the medical behavior.
3, the implementation of beauty and cosmetic surgery, health care, the installation of artificial limbs, prosthetic teeth, prosthetic eye and other medical behavior.
(2) The following expenses are not covered by the Basic Medical Insurance Fund for Urban Residents:
1. Expenses for medicines that are not covered by the Basic Medical Insurance Drug List for Urban Residents.
2, beyond the urban residents on the 10 billion annual medical insurance diagnosis and treatment items other than the provisions of the diagnosis and treatment costs.
3, beyond the basic medical insurance service facilities beyond the uniform service costs.
4, registration fee, outpatient medical record cost, patient hospitalization escort fee, ambulance fee, out-of-hospital consultation fee, medical staff consultation fee and travel fee, out-of-hospital consultation fee, medical staff consultation fee and travel fee, qigong fee, weight loss fee, smoking cessation fee, drug addiction treatment fee, sexually transmitted diseases (except AIDS) treatment fee, etc..
5. Medical expenses incurred in traffic accidents.
6. Medical expenses incurred in medical accidents.
7. Expenses incurred for childbirth and family planning.
8. Expenses incurred for forensic appraisal and labor disability appraisal.
9. Medical expenses incurred outside the country (including Hong Kong, Macao and Taiwan).
10. Medical expenses paid within the scope of other insurance and other claims.
11. Other expenses that are not paid according to the regulations.
Xxii. How many hospitals can the insured urban residents choose for their first consultation?
Basic medical insurance for urban residents implements a system of first consultation and two-way referral based on township (community) health service organizations. Insured residents can choose one township (community) health service organization as their first medical institution. For those who suffer from specialized diseases, they can choose one additional specialized hospital as their first point of hospitalization, and fill in the "Registration Form of Application for Participation in Urban Residents' Basic Medical Insurance in Honghe Prefecture".
What are the rules for the transfer of insured residents to other hospitals due to critical conditions and medical restrictions?
In principle, insured residents should seek medical treatment at the first designated medical institution and locally. In the event that a referral is necessary due to critical conditions and limitations in medical conditions, the provisions for referral and transfer are implemented in accordance with the provisions for referral and transfer at each level. The physician in charge of the designated medical institution shall firstly put forward the opinion of referral and transfer to the hospital, which shall be approved by the director in charge and then go to the county or city medical insurance agency to go through the approval procedures, and the referral and transfer to the hospital shall be allowed only after the approval is granted. The approval for referral is valid within three days, and the approval for transfer to hospital is valid within seven days. If it is too late to go through the procedures of referral and transfer to hospital due to the critical condition, the procedures should be made up within seven days of referral and transfer to hospital, otherwise the medical expenses will not be reimbursed.
Twenty-four: What should the insured residents do if they are hospitalized in a different place due to an emergency?
Participating residents who are hospitalized in a different place due to an emergency should report to the local county or municipal health insurance agency within three days of hospitalization, and will be reimbursed for their hospitalization medical expenses only after approval and filing.
Twenty-five: What kind of documents should the insured residents bring with them when they are sick and need to be hospitalized?
Participating residents who need to be hospitalized must bring their social security cards and medical insurance cards for admission procedures.
26. What is the procedure for settling the medical expenses incurred by the insured residents when they are hospitalized at the designated medical institutions in the insured area?
(1) The designated hospital first calculates the total hospitalization expenses according to the charges of "Non-profit Medical Service Prices in Yunnan Province" and the payment standards of basic medical insurance for urban residents;
(2) the individual's out-of-pocket part of the total medical expenses is calculated in accordance with the regulations of the basic medical insurance for urban residents;
(3) after signing the approval by the insured residents or their families, the out-of-pocket part is paid by the individual.
The self-paid portion of the medical expenses shall be paid by the individual, and the rest shall be settled between the designated medical institution and the medical insurance agency.
XXVII. How are the medical expenses for referral, transfer to other hospitals or other places settled?
(1) The medical expenses for referral, transferring to another hospital or visiting a different place for medical treatment shall be paid by the individual first, and then the insured resident himself or his delegate shall go to the local medical insurance agency for examination and reimbursement after being discharged from the hospital.
(2) When making reimbursement, one must provide valid documents such as the approval form for referral, transfer, medical insurance card, social security card, certificate of discharge, fee invoice, detailed list of hospitalization expenses and other valid documents.
(3) The time limit for reimbursement of medical expenses for referral, transfer or off-site medical treatment is 30 days after discharge from the hospital, and reimbursement will not be made beyond 30 days. Exceptions are delays caused by special reasons such as incomplete reimbursement materials that need to be supplemented, or encountering disasters other than those mentioned above.
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