District-directed medical insurance
1. Basic medical insurance benefits
(1) Sources of personal account funds
1. Individual contributions from employees The basic medical insurance premium and my total salary 2 are all transferred to my personal account.
2. The total amount of basic medical insurance premiums paid by the employer 8 (6 in 2002) shall be transferred to the personal account according to the regulations. The specific division method is 0.5 for 45 years old and below; 46 years old and above 59 years old. 1; 1.5 for those aged 60 and over.
(2) Sources of the overall pooling fund
Except for the prescribed portion of the basic medical insurance premium paid by the employer that is transferred to the individual account, the rest goes into the basic medical insurance pooling fund.
(3) Payment scope of personal account
Personal account is mainly used to pay for outpatient medical expenses that comply with the basic medical insurance drug catalog and diagnosis and treatment items; payment for hospitalization should be paid by the individual himself Medical expenses; payment for special examinations, special treatments and outpatient medical expenses for some outpatients with chronic diseases.
(4) Payment scope of the overall fund
1. Hospitalization medical expense payment: medical expenses incurred during hospitalization that comply with the provisions of basic medical insurance: above the minimum payment standard, the maximum payment limit Most of the following are paid by the overall fund according to the segmented accumulation method, and individuals also have to pay a certain proportion out of their own pocket:
Payment ratio from the overall fund and individual payment ratio
Hospitalization medical expenses while employed Retirement, working retirement
Minimum payment is above 5,000 yuan 70752015
5000-10,000 yuan 75801510
10,000 yuan to the maximum limit 8085105
2. The maximum payment limit of the overall fund within a year is 4 times the employee's annual salary. Medical expenses exceeding the maximum limit will no longer be paid by the overall fund. Insured persons will pay in cash and will be settled through commercial medical insurance and other channels.
II. Interim Provisions on Medical Subsidy for National Civil Servants
(1) Scope of Subsidy
1. Medical treatment that meets the standards of basic medical insurance diagnosis and treatment items and medical service facilities Cost and drug list.
2. Part of the medical expenses exceeding the maximum payment limit of the basic medical insurance fund.
3. Individuals pay out-of-pocket medical expenses exceeding a certain amount within the payment scope of basic medical insurance.
4. Medical expenses incurred by medical caregivers when they receive medical care in accordance with regulations.
5. Work-related injuries and maternity medical expenses that are eligible for national civil servant medical subsidies.
(2) Outpatient medical subsidy
In compliance with the provisions of basic medical insurance, a single medical expense is incurred:
A subsidy of 55 for employed personnel (the total outpatient medical expenses within one year exceeds 1,600 yuan or more) will no longer be subsidized.
The 65 subsidy for retirees (the total outpatient medical expenses in one year exceeds 1,800 yuan) will no longer be subsidized.
The 90 subsidy for medical caregivers (the total outpatient medical expenses exceed 2,000 yuan within one year) will no longer be subsidized.
(3) Hospitalization subsidy
1. Inpatient bed fee subsidy: For the excess of the basic medical insurance bed fee of 15 yuan or more, the daily subsidy is: 10 yuan for working personnel and 10 yuan for retired people. Personnel subsidy is 15 yuan, and medical care personnel subsidy is 25 yuan.
2. The medical expenses incurred during hospitalization within one year shall be borne by individuals above the minimum payment standard and below the maximum payment limit of the basic medical insurance co-ordination fund, such as Class B drugs, Class B materials, and Class B diagnosis and treatment items. And for the segmented accumulated personal out-of-pocket expenses, the subsidies are: 85 yuan for working personnel, 90 yuan for retirees, 95 yuan for medical care personnel, and 100 yuan for health care recipients.
3. The subsidy for using drugs other than those listed in the basic medical insurance drug list during critical illness is: 50 yuan for working personnel, 60 yuan for retirees, and 90 yuan for medical caregivers.
The method for this subsidy is that the doctor fills out an application form, submits it to the medical insurance center for approval, and then settles the bill in cash. Bring the hospitalization invoice and application consent form to the medical insurance center for reimbursement according to regulations.
3. Medical Treatment for Some Outpatient Chronic Patients
1. The diseases listed as outpatient chronic diseases include: coronary heart disease, diabetes, various malignant tumors, chronic obstructive emphysema, Immune modulation treatment for hypertension, Parkinson's disease, decompensated liver cirrhosis, uremia, chronic heart failure, and anti-rejection after organ transplantation.
2. Each insured person can declare up to 3 diseases.
3. According to regulations, outpatient chronic diseases can only enjoy the drugs on the medical insurance drug list within the scope of the chronic disease.
4. Before entering the chronic disease subsidy, the individual must first pay the drug expenses below the standard out of pocket, that is, the average annual total salary of the employee is 8, and the remaining drug expenses will be paid into the overall fund in proportion.
IV. Payment ratio for special inspection and special treatment items
1. According to regulations, for part of the special inspection and special treatment, the individual first pays 40% of the fee, and the remaining fee is based on the proportion stipulated by the basic medical insurance Payment, personal payment part will be subsidized according to the proportion and limit of civil servant subsidy.
2. For the use of imported materials, the individual shall first pay in cash at a ratio of 50%, and the remaining expenses shall be subsidized in accordance with the provisions of Article 1.
5. Injury medical benefits for employees of central government agencies and institutions directly stationed in Yong (public)
According to the spirit of Guilaoshe Medical Insurance (2002) No. 9 document:
1. For employees of government agencies and institutions directly stationed in the Central District who are eligible for the national civil servant medical subsidy, the medical expenses for work (official) injuries that meet the regulations will be reimbursed from the national civil servant medical subsidy funds.
2. Employees of central district agencies and institutions directly stationed in Yong who suffer work-related injuries must report to the Medical Insurance Office of the District Labor Department within 48 hours by phone and fill in the form within 15 days (central district directly stationed in Yong) The employee injury accident report form is made in triplicate. Employees who are recognized as work-related injuries by the administrative department of the Autonomous Region Labor and Social Security Department shall enjoy work-related injury medical treatment in accordance with regulations.
3. Employer and work-related injuries. Employees must provide the following certificates
Work-related injury accident report form, designated hospital diagnosis certificate or occupational disease diagnosis certificate, relevant inquiry records and circumstantial evidence materials; in the event of a traffic accident, provide the traffic police department’s responsibility determination for handling the accident.
4. After an employee of an institution directly stationed in the Central District suffers a work-related injury, the designated hospital is currently designated as the First Affiliated Hospital of Guangxi Medical University (including the Second Affiliated Hospital, which is the West Hospital). ). Guangxi District People's Hospital, Guangxi Workers' Hospital, Nanning Second People's Hospital. Critically injured patients can be rescued at the nearest hospital and then transferred to a designated hospital for continued treatment after their injuries are stable.
5. ) During the medical treatment period for injured workers, the Guangxi Zhuang Autonomous Region Urban Employee Basic Medical Insurance Diagnosis and Treatment Project, the scope of medical service facilities and payment standards, and the Guangxi District Basic Medical Insurance Drug Catalogue can be appropriately relaxed, but the scope of use of drugs must be provided to the autonomous region. Application and approval by the Social Security Bureau.
6. Hospitalization medical expenses that comply with the relevant provisions of basic medical insurance during the treatment of work-related injuries will be fully reimbursed in the national civil servant medical subsidy.
7. Recognition. Expenses incurred by employees injured at work during outpatient and hospitalization periods are first advanced by the unit in cash, and then they are submitted to the Autonomous Region Social Security Bureau for review and reimbursement with the work-related injury approval form, medical insurance certificate, hospital certificate, medical expense list, etc.
6. Management of personal medical insurance IC cards
1. Personal medical insurance IC cards record the medical insurance file information of insured persons, personal account funds and usage status, and are kept and used by individuals.
2. The principal and interest of a personal account belong to the individual, and in principle no cash withdrawal is allowed.
3. When the IC card is lost or damaged, go to the district medical insurance center with your personal ID card. If you are unable to report the loss at the moment, you can call the district medical insurance center to report the loss in advance to avoid unnecessary losses. The loss report phone number is 2853836.
Municipal medical insurance
1. Medical benefits for specific outpatient items
1. The scope of specific items is: radiotherapy and chemotherapy for malignant tumors, uremic dialysis treatment, organ Anti-rejection treatment after transplant surgery.
2. For insured persons who meet specific items, the doctor shall submit a written application for each medical visit, and the expenses incurred after going through the approval procedures shall be borne by the working person 15%; the retired person shall bear 8% personally, and the remaining expenses shall be entered into the Coordinate fund payments.
3. If an insured person over 50 years old suffers from serious chronic diseases in the outpatient clinic and the cumulative medical insurance drug cost exceeds 500 yuan within 30 days, he should go to the municipal medical insurance center with the outpatient drug invoice and medical record to fill in the drug expense reimbursement form and press Provide for reimbursement.
II. Management and fee payment of special prosecution and special treatment
1. For special prosecution and special treatment projects approved upon application, current employees shall pay RMB 30; retired persons shall pay RMB 15.
2. For hospitalized patients who need approved imported artificial organs and implanted materials due to their condition, the cost of the implanted materials must be paid by the individual in advance, and then reimbursed according to regulations at the Municipal Medical Insurance Center with other relevant information.
3. Medical mutual aid payment benefits
1. For employees participating in medical mutual aid, if the payment exceeds the maximum limit of the unified fund, the excess medical expenses will be paid in cash. The Municipal Medical Insurance Center will provide reimbursement from the medical mutual aid fund in accordance with regulations.
2. The maximum limit of overall fund payment is four times the average total salary of employees in the previous year.
3. Hospitalization expenses incurred in the coordinated area in the first half of the year shall be less than 9 times (including 9 times) of the average employee salary. The medical mutual aid fund shall be 70 RMB, and the individual shall pay 30 RMB out of pocket; the average salary shall be more than 9 times and less than 13 times (inclusive). 13 times) The medical mutual aid fund pays 80, and the individual pays 20 out of pocket; the average salary is more than 13 times to 15 times, and the medical mutual aid fund pays 90, and the individual pays 10 out of pocket.
The scope of medical treatment items that are not covered by basic medical insurance is divided into the following categories
1. Service items
1. Registration fee, out-of-hospital consultation fee, house call fee, expedited examination and treatment fee, roll call surgery surcharge, self-recruited nurse special medical services.
2. Various beauty, bodybuilding and non-functional plastic surgery and orthopedic surgeries.
3． Various weight loss, weight gain, and height gain programs.
4. Various health examinations and medical appraisal fees.
2. Diagnostic equipment and medical materials
1. Applied electricity
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