Supplementary medical insurance management approach

2017 Supplementary medical insurance management methods

Supplementary medical insurance is not mandatory through national legislation, what do you know about supplementary medical insurance management methods? Why not take a look together!

Article 1 In order to establish and improve the multi-level medical insurance system, to reduce the level of personal medical burden of urban workers medical insurance for patients with serious illnesses and low-income, special hardship, severe disability, according to the "Municipal Government Office of the adjustment of urban workers in Xuzhou urban area of the basic medical insurance policy of relevant Notice" (Xu Zhengban Fa [2009] No. 124) and "Municipal Government on the adjustment of urban urban workers' basic medical insurance policy notice" (Xu Zhengzhi [2011] No. 12) documents, the formulation of this interim measures.

Article 2 All urban workers who participate in the city's urban workers' basic medical insurance shall participate in urban workers' supplementary medical insurance (hereinafter referred to as supplementary medical insurance).

Article 3 Supplementary medical insurance fund by the participants of the individual account and the overall fund in accordance with the standard of 1 yuan per person per month and 2 yuan, and before the end of January each year, a one-time payment of the whole year. According to the social and economic development and the operation of the fund, may be appropriate to adjust the financing standards of supplementary medical insurance.

Article 4 of the municipal social insurance agency to develop the annual budget of the supplementary medical insurance fund collection plan, and accordingly transfer the individual account and the overall fund to pay the funds. If the balance of funds in the individual account is insufficient, it will be deducted from the amount transferred to the account in the next period. Participants who do not establish individual accounts should pay the annual fee for medical assistance for major illnesses in a lump sum for that year.

Article 5: Newly insured employees shall pay the supplementary medical insurance premiums for the remaining months of the year in a lump sum in the same month of their enrollment according to the payment standard.

Article 6 The use of the supplementary medical insurance fund adhere to the principle of income and expenditure, balance of income and expenditure, separate accounts, separate accounting, separate management.

Article 7 Within a co-ordination year, on the basis of the basic medical insurance for urban employees and medical assistance for major illnesses, medical expenses within the scope of the policy incurred by insured persons due to hospitalization (in line with the provisions of the three directories of basic medical insurance, except for out-of-pocket expenses), the starting standard shall be set at about 50% of the per capita disposable income of the local urban residents in the previous year, with a starting standard of 10,000 yuan for the 2013 year. In 2013, the starting standard was set at 10,000 yuan. For the part that exceeds the starting payment standard, the supplementary medical insurance fund determines the payment ratio according to the level of medical expenses, and in principle, the higher the medical expenses, the higher the payment ratio, without setting a maximum payment limit, and the payment ratio is not less than 50%. Low-income, special hardship, seriously disabled persons, in principle, the proportion of the fund to pay the other participants in the proportion of payment on the basis of an increase of 10 percentage points.

Article 8 has enjoyed the supplemental medical insurance treatment of the insured, the medical insurance fund will not arrange separate funds for subsidies.

Article IX Municipal health insurance agencies before the end of March each year to put forward the previous year's subsidy program, reported to the Municipal Human Resources and Social Security Bureau for approval and implementation.

Article 10 These measures shall come into force from 2013. All counties (cities) and Tongshan District may refer to these measures and establish a supplementary medical insurance system in accordance with local practice.

1 Preparation and Scope of Application

These Measures are prepared by the Human Resources Section of SAIC-GM-Wuling Automobile Company Limited, and they are applicable to the company's control and management of supplementary medical insurance benefits.

These measures are applicable to employees who have signed labor contracts with SAIC-GM-Wuling Automobile Co.

2 Terminology

Supplementary medical insurance: It refers to the supplementary medical insurance benefit established by the enterprise according to the operation condition on the basis of participating in basic medical insurance according to the law.

3 Basic Principles

3.1 Regulate the management of supplemental medical insurance benefits, taking the safety and health of employees as the working guideline.

3.2 Continuously optimize the supplementary medical insurance benefits in accordance with the needs of the company's business development and the requirements of employees.

3.3 Strengthen the supervision and management of suppliers.

4 Responsibilities

4.1 The Human Resources Section is the centralized management department of the supplementary medical insurance, and is responsible for the budgeting, operation control and optimization of the supplementary medical insurance promotion

4.2 The company's executive committee or the company's executive committee's authorizer is responsible for the approval of the supplementary medical insurance program;

4.3 The Finance Section examines and approves the budget and pays the premiums of the supplementary medical insurance. medical insurance budget and pay premiums;

4.4 The company's labor union assists the Human Resources Section in publicizing the supplemental medical insurance policy, implementing the supplemental medical insurance benefits and participating in the optimization of the program;

4.5 The Purchasing and Supply Chain Management Center procures suppliers of the supplemental medical insurance and signs the agreement on the insurance;

4.6 Each department is responsible for publicizing the supplemental medical insurance policy in its own department. medical insurance policy to their departments.

5 Working Procedures

5.1 Supplementary medical insurance includes protection insurance and management insurance. The insurance responsibility of protection type insurance includes death from illness, death or disability caused by accidental injury, outpatient or hospitalization expenses caused by accidental injury and hospitalization subsidy, etc.; the insurance responsibility of management type insurance includes inpatient medical treatment, inpatient medical allowance and female employee's disease, etc. The specific protection items and protection standards are based on the employees' needs. Specific protection items and protection standards are set according to the nature of the employee's work, occupational risk and other circumstances.

5.2 Supplementary medical insurance. Annual routine work includes budget preparation and review, premium payment, daily management, settlement at the end of the insured year, optimization and renewal work, and the specific implementation of the annual routine business control process of the supplementary medical insurance, which is shown in Figure 1.

5.3 According to the changes of the economic and legal environments and the needs of the company's business development, the supplementary medical insurance shall be optimized and adjusted accordingly. The Human Resources Department shall put forward optimization proposals, organize trade unions and other relevant departments for discussion, and submit them to the Executive Committee of the Company or the authorized person of the Executive Committee of the Company for approval and implementation as required.

5.4 After the approval of the supplementary medical insurance plan, the Human Resources Section organizes the trade unions and departments to promote the policy, and the trade unions and departments promote the policy to the employees in the region as required.

6 Bylaws

6.1 This system is implemented from the date of publication.

6.2 The right to interpret this system is vested in the Human Resources Section.

In order to implement the requirements of the Road Bureau and the Party Committee of the Road Bureau on precise assistance, effectively reduce the medical burden of employees in special and severe hardship, and give full play to the protection and incentive role of enterprise supplementary medical insurance, according to the "Guiding Opinions of China Railway Corporation on Regulating the Management of Supplementary Medical Insurance of Enterprises" (Tielao Health [2014] No. 98), the spirit of the document, is now "Taiyuan Railway Bureau of enterprise supplementary medical insurance management approach (for trial implementation)" (Tai Railway Social Security [2015] No. 463) is revised, put forward the following additions, has been the Road Bureau of the Party and Government Joint Meeting and Road Bureau of the Second Staff Council of the fourteenth joint meeting to consider and adopt, please comply with the implementation.

I. Scope and standard of medical fee subsidies for employees in special hardship

1. Scope of subsidies

Employees in special hardship should comply with the relevant provisions of the Bureau's basic medical insurance for the insured employees to purchase medicines. Hospitalization and outpatient medical expenses incurred for major diseases by the basic medical insurance, major disease insurance, enterprise supplementary medical insurance and road bureau to help aid the medical assistance, the individual part of the costs borne by the subsidy (including out-of-pocket expenses, limited to medicines, inspections, treatment costs. Including compliance with the provisions of the use of blood protein products, implanted materials in the body fee, excluding all types of organ or tissue transplantation of organ or tissue source costs; excluding basic medical insurance does not pay for the cost of diagnostic and treatment items directory of services, non-disease treatment items, treatment items and other items listed in the category of costs).

The list of in-service special hardship workers is provided by the Road Board Help and Assistance Office, and the list of retired special hardship workers is provided by the Road Board Retirement Office.

2. Subsidy standards

A natural year, the personal burden of medical expenses accumulated over a certain amount, the use of section calculation, cumulative payment method for subsidies, the maximum annual subsidy of 100,000 yuan.

(1) the cumulative amount of 1000?30000 yuan (including 30000 yuan), the subsidy rate of 85%;

(2) the cumulative amount of 30001?100000 yuan (including 100000 yuan) the subsidy rate of 70%;

(3) cumulative amount of more than 100000 yuan subsidy rate of 50%.

Second, the scope and standard of medical fee subsidies for dependent relatives of workers in special hardship

The medical fees incurred by dependent relatives of workers in special hardship who are hospitalized and recognized by the local urban residents' medical insurance or the New Agriculture Cooperative Medical Insurance as outpatient large amount of disease, and the medical fees paid by individuals out of their own pockets (excluding out-of-pocket expenses) after being paid by the integrated fund of the urban residents' medical insurance or the New Agriculture Cooperative Medical Insurance and the Fund of the Major Disease Insurance, the enterprise supplemental medical insurance subsidizes 70% of the medical fees. The enterprise supplemental medical insurance subsidizes 70% of the medical expenses. In a natural year, the cumulative maximum subsidy limit for each dependent relative is 50,000 yuan.

If the dependent relatives of an employee in special hardship suffer from a serious disease but do not meet the age requirement, they will be treated as if they are completely disabled.

Third, the insured workers suffering from serious illnesses subsidies

Road Bureau insured workers suffering from serious illnesses incurred medical expenses, the year by various types of medical insurance and road bureau to help aid medical aid, the actual burden of personal expenses (the scope of subsidies with the same as the special hardship workers) more than 100,000 yuan above the portion of the road Bureau of Social Security Office according to the degree of family hardship and other factors, within a ratio of no more than 70% to propose a subsidy program. The subsidy program is proposed by the road bureau party and government joint meeting after the study and approval by the social security office issued.

Fourth, the scope and standard of medical fee subsidies for model workers

The scope of the model workers for the "Taiyuan Railway Bureau Taiyuan Railway Bureau Trade Union on the issuance of & lt; railroad model workers and advanced workers management service work a number of provisions of the implementation of the rules & gt; notice" (Taiyuan Railway Office 〔2014〕 No. 230) document referred to as the model workers of the railroad. The medical expenses incurred by the labor model are subsidized in accordance with the scope and standard of medical subsidy for special hardship workers. The list of model workers is provided by the road bureau labor union.

Fifth, the subsidy time

Special hardship workers and dependent relatives, the model of the medical costs of subsidies uniformly in the first quarter of the following year for processing. The medical expense subsidies for employees suffering from serious diseases should be processed in time.

VI. Other

1. The determination or change of the proportion of the enterprise's supplementary medical insurance premiums should fulfill the relevant decision-making procedures of the Road Board.

2. After the road bureau decision-making process to determine or change the proportion of corporate supplementary medical insurance premiums, should be issued a clear document, and by the financial sector in accordance with the prescribed proportion of the calculation and expenditure of corporate supplementary medical insurance costs.

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