Xuzhou medical insurance personal account transfer ratio

People's governments of counties (cities) and districts, Xuzhou Economic and Technological Development Zone, the new city management committee, the city's commissions, offices, bureaus (companies), the city's directly under the unit:

In order to implement the "Social Insurance Law", to further improve the urban workers in the city's basic medical insurance (hereinafter referred to as "medical insurance") policy, to ensure that the insured enjoy medical insurance benefits in accordance with the law. In order to further improve the urban workers' basic medical insurance (hereinafter referred to as "medical insurance") policy, to ensure that the insured enjoy medical insurance treatment in accordance with the law, the municipal government has decided to adjust the relevant policies of medical insurance, the relevant matters are hereby notified as follows:

First, the medical insurance system to implement the minimum number of years of contributions and the actual number of years of contributions to the combination of the system

(a) Participation in the implementation of the medical insurance system of years of contributions, the number of years of contributions, including the number of years of deemed contributions and the actual number of years of contributions.

(2) August 1, 2000 before the start of the city's health insurance system, the insured workers in line with the national and provincial provisions of the length of service or years of work, as a health insurance deemed to contribute to the number of years; the actual number of years of health insurance contributions only refers to August 1, 2000 after the participation of employees in the actual number of years of health insurance contributions.

(C) participants enjoy retiree health insurance benefits, must also meet the following conditions:

1, the legal retirement age and retirement procedures for participants, before retirement in a continuous state of insurance;

2, the cumulative number of years of medical insurance contributions, men over 25 years, women over 20 years;

3, the actual number of years of contributions for more than 10 years.

Participants in line with the provisions of the preceding paragraph, after retirement, no longer pay the basic medical insurance premiums, enjoy retiree medical insurance benefits.

Retirement procedures and enjoy the pension insurance benefits, but did not reach the above specified number of years of participants, in accordance with the provisions of the contribution base, the contribution rate in a one-time retroactive contribution or continue to contribute to the specified number of years, enjoy the retiree medical insurance benefits.

(d) The specific implementation of the contribution period by the municipal human resources and social security departments to develop.

Second, adjust the proportion of medical insurance units participating in the contribution

(a) the proportion of participating units to pay the basic medical insurance premiums adjusted from 7% to 9%. Participants in the 2% contribution rate remains unchanged.

(b) and the employer to terminate the labor (personnel) relationship, as well as other flexible employment to participate in medical insurance, you can pay the basic medical insurance premiums at a rate of 11% to enjoy the basic medical insurance treatment; you can also pay the basic medical insurance premiums at a rate of 6% to enjoy the hospitalization (including the family beds) medical insurance treatment, but do not transfer the funds to the individual account, do not enjoy the integrated fund to pay for the outpatient treatment. The outpatient treatment paid by the integrated fund is not available. Choose to participate in the above forms of insurance, a comprehensive year will not be changed.

Third, an appropriate reduction in the proportion of basic medical insurance premiums into individual accounts, reduced funds for outpatient coordination

The basic medical insurance premiums paid in accordance with the different ages of participants to determine the proportion of the individual account:

1, 35 years of age (including 35 years of age) under the proportion of the transfer of the adjusted from 3% to 2.5%;

2, 36 years of age and older than 45 years of age into the proportion of 3.3% adjusted to 2.5%;

2, 36 years of age and older than 45 years of age into the proportion of 3.3% adjusted to 3.3%;

2, 36 years of age to 45 years of age to transfer Proportion of 3.3% adjusted to 2.8%;

3, 46 years of age (including 46 years old) to the retirement of the allocation of the proportion of 4.2% adjusted to 3.7%;

4, 69 years of age (including) of the following retirees of the allocation of the proportion of 6% adjusted to 5%; 70 years of age (including) more than the retirees and the establishment of the old workers to participate in the revolutionary work of the allocation of the proportion of 7% adjusted to 6%.

Fourth, the appropriate expansion of the use of individual account funds

The balance of funds in the individual account in the original provisions of the purpose (to pay for their own hospitalization, outpatient clinics, pharmacies, home hospital beds and other personal out-of-pocket part of the costs of medical insurance coverage, the integrated fund of the starting standard costs, as well as the payment of their own medical assistance for serious illnesses and medical check-ups, preventive vaccination and other costs) based on the expansion of the use of the funds for payment for Medical insurance drug catalog outside of all permitted drugs, but its costs are not accumulated in the starting standard.

V. Adjustment of the starting standard for hospitalization in the city

(a) the starting standard for hospitalization in the city: third-level medical institutions from 800 yuan to 900 yuan; second-level medical institutions from 300 yuan to 400 yuan; first-level medical institutions, community health service institutions, the starting preparation of 100 yuan remains unchanged. Low-income, special hardship (refers to holders of "Xuzhou City, special hardship workers card" special hardship workers, the same below) and severe disability according to the above standard 50% implementation; 69 years of age (including) the following retirees according to the above standard 65%, 70 years of age (including) more than the retirees and the old workers to participate in the revolutionary work of the founding of the country before the implementation of the standard of 50% remains unchanged.

(2) The starting standard for multiple hospitalizations in secondary and tertiary medical institutions within a year is reduced by 100 RMB in descending order, but the minimum for tertiary medical institutions is not less than 300 RMB, and the minimum for secondary medical institutions is not less than 200 RMB.

(C) enjoy the outpatient treatment of specific items of the insured, the same year in the city outpatient and inpatient hospitalization cumulative maximum starting standard does not exceed 10% of the city's last year the average salary of urban non-private sector on-the-job workers.

(d) Low-income, special hardship and severe disability should be eligible to declare registration, and by the health insurance agency for the annual audit.

VI. Adjustment of outpatient co-ordination (including general outpatient, part of the outpatient chronic disease, the same below) approach, the implementation of outpatient co-ordination, outpatient specific items to choose a designated unit of medical treatment, purchase of medication management

(a) outpatient co-ordination fund to pay for the scope. Outpatient coordinated fund to pay the primary health care institutions in the occurrence of medical insurance class A drugs (including basic drugs), general diagnosis and treatment fees and other prescribed diagnosis and treatment fees, as well as medical insurance to pay for the cost of traditional Chinese medicine within the scope of the cost of tablets.

(2) The starting standard for outpatient medical insurance is 1500 RMB in a year. Low-income, special hardship, severe disability according to the implementation of 50%; 69 years of age (including) the following retirees, 70 years of age (including) and above retirees and outpatient chronic diseases of the old workers who participated in the revolution before the founding of the country, respectively, 65%, 50% implementation.

(C) outpatient co-ordination, outpatient specific items for the temporary implementation of the choice of fixed-point unit management. Participants should choose a designated primary medical institutions, a secondary or tertiary designated hospitals and a designated retail pharmacy to purchase drugs. Participants who are entitled to specific outpatient programs can only choose one designated medical institution for medical treatment. Once a fixed-point organization is selected, it cannot be changed within one year. If you do not choose a designated unit in accordance with the provisions, the costs incurred will not accumulate the outpatient starting standard, and will not be entitled to the outpatient treatment paid by the integrated fund.

The costs incurred in purchasing medicines at the selected designated units and Class A pharmacies will be counted towards the outpatient outpatient coordinator's starting payment standard.

When the cost of medication exceeds the threshold for outpatient care during the year, only medical expenses incurred at the selected designated medical institutions and Class A pharmacies can be subsidized by the Outpatient Coordination Fund in accordance with the regulations.

In addition to the medical insurance designated specialist medical institutions and specialized outpatient medical institutions and Chinese medical institutions, as well as emergency and first aid, in the selection of other designated units for the purchase of medicines can only be used in the individual account funds, and is not included in the outpatient outpatient coordination of the starting standard, the coordinated fund will not be paid.

In accordance with the provincial health department and other six departments issued "on the establishment of public hospitals and urban and rural basic health care institutions up and down the linkage between the division of labor and coordination mechanism of the views" (Su Wei medical [2011] No. 70) spirit, led by the municipal health department, as soon as possible to establish the "grass-roots first diagnosis, hierarchical medical care, emergency and slow treatment, two-way referral" diagnosis and treatment model, basic medical care, and the first time to the hospitals, the hospitals and the hospitals, the hospitals and the hospitals. The primary healthcare institutions should establish two-way referral relationship with higher level hospitals to form a long-term stable and institutionalized collaboration mechanism, so as to provide convenient and low-cost basic healthcare services for the public. With the two-way referral system established and improved, and gradually expand the scope of payment of medical insurance fund to meet the prescribed referral costs.

(D) outpatient chronic disease medication scope in the original only on the basis of chronic disease medication to increase the medical insurance class A drugs.

(e) participants in the implementation of zero-differential rate sales of essential drugs in primary health care institutions (including love hospitals), over the threshold of the costs incurred, outpatient coordinated fund will be subsidized at a rate of 75%; in other primary health care institutions and Class A designated retail pharmacy, 70% subsidies; in the second level of hospitals, 60% subsidies; in the third level of hospitals, 50% subsidies. 69 years old ( including), 70 years old ( including) or less, and 70 years old ( including) or less, and 50 years old ( including) or less, and 70 years old ( including) or less, and 70 years old ( including) or less, and 50 years old (including). 69 years of age ( including ) below, 70 years of age ( including ) above retirees and old workers who participated in the revolutionary work before the founding of the country on the basis of the above subsidy ratio increased by 5 and 10 percentage points respectively.

(f) A comprehensive year, the maximum subsidy limit of the general outpatient clinic fund is 1200 yuan. On this basis, three outpatient chronic diseases increased to 1500 yuan, two outpatient chronic diseases increased to 2000 yuan, one outpatient chronic diseases increased to 2500 yuan.

VII. Adjustment of civil service medical subsidies

(a) civil service medical subsidies to raise funds for the standard is still based on the previous year's salaries and retirees in the total amount of 4% of the implementation of the retiree's retirement. Raised civil service medical subsidies, for those who do not enjoy the outpatient specific projects, outpatient chronic disease treatment, according to the standard of 1% of the base of their salary contributions monthly into a personal account for outpatient medical care and can be carried forward; the rest of the subsidies for outpatient chronic disease, outpatient specific projects, inpatient hospitalization, and other medical subsidies.

(2) civil servants outpatient chronic medical costs, first by the basic medical insurance outpatient fund to subsidize the medical costs incurred after reaching the maximum subsidy limit, by the civil service subsidy funds to be re-subsidized; re-subsidized scope of payment, subsidy ratio and subsidy limit and the same as the basic medical insurance outpatient coordinator.

(C) civil servants inpatient and outpatient specific items of medical assistance in accordance with the original provisions.

VIII, further improve the settlement of medical expenses and the management of the classification of medication paid by the health insurance

(a) designated medical institutions in line with the "Jiangsu Province Diagnostic Standards for Acute and Critical Illnesses" of the acute and critical inpatient hospitalization, an appropriate increase in the total amount of special control, the end of the year settlement; through the implementation of the health sector to promote the management of clinical pathway, and the active implementation of hospitalization single-patient payment.

(ii) in the protection of basic medical needs on the basis of health insurance "Drug Catalog" within the same dosage form specifications of drugs, set the maximum payment limit standard; B drugs in the main role of auxiliary treatment of medicines, an appropriate increase in the proportion of individuals to pay first, and other B drugs to open the payment ratio of the grades.

Specific measures by the municipal human resources and social security departments in conjunction with the city health, finance departments.

IX, the establishment of the mechanism of medical assistance to patients with serious illnesses and vulnerable groups

Each year, according to the health insurance fund budget increase in the situation of special funds set aside for the year of patients with serious illnesses and low-income, special hardship, severely disabled people's medical assistance. Specific programs by the municipal human resources and social security departments in conjunction with the financial sector *** with the development.

X. Establishment of incentives for participants who do not use the integrated fund of health insurance

The integrated year of participants who do not use the integrated fund of health insurance, you can choose one of the following incentives:

1, participants with individual accounts more than 1,000 yuan, the following year, you can apply for the "Exclusive Card", from the individual account transferred to the more than 1,000 yuan, used to pay for the individual or a relative at a designated medical institution for medical treatment. Relatives in the designated medical institutions, designated retail pharmacies to purchase drugs, can also be used for fitness consumption.

2. Participants who do not choose to apply for the Exclusive Card will have 50 RMB transferred to their personal account from the integrated fund in the following year for the payment of medical assistance for major diseases.

XI, bylaws (a) This notice from January 1, 2012 onwards. Previous documents inconsistent with the provisions of this notice, this notice shall prevail.

(2) The counties (cities), Tongshan District, according to local practice, can refer to the implementation of this notice.

(3) This notice is interpreted by the municipal human resources and social security administration.

December 22, 2011