Where are you from? For your reference, we are providing the one for Zhangjiakou City, Hebei Province!
Zhangjiakou City workers major illnesses medical mutual aid activities implementation measures (fourth)
Chapter I General Rules
Article 1 workers major illnesses medical mutual aid activities is the solidarity and mutual assistance within the working class, poverty alleviation and help the poor a public welfare activities, is the working class to help people carry forward the glorious tradition of the carry forward and glory, is the trade union organization to send warmth to the project of the development and continuation of an important part of the party and the government to pay attention to people's livelihood and protect people's livelihood work. It is the development and continuation of the project of sending warmth to trade union organizations, and is an important part of the work of the Party and the government to pay attention to people's livelihood, protect people's livelihood and improve people's livelihood. By the Provincial Federation of Trade Unions and the municipal government agreed, the development of this approach.
Second employee medical assistance for major illnesses is an important supplement to the employee medical insurance system, is an important part of the trade union assistance system, which is led by the party committee, the government (administrative) support, trade unions operate, the workers to participate in the mutual benefit of a mass mutual aid activities.
Article 3: The purpose of the workers' major illness medical mutual aid activities is to provide financial assistance to workers suffering from major illnesses, to alleviate the financial burden of workers suffering from major illnesses, and to enable sick workers to receive medical treatment for their illnesses.
Article 4: The principle of "combining rights and obligations, starting from the actual situation, living within one's means, and not aiming at profit-making" shall be adhered to in the activities of medical mutual aid for workers suffering from major illnesses.
Chapter II leading organizations, departments and functions
Article 5 Zhangjiakou City, the leading group of workers with major medical illnesses mutual aid activities (hereinafter referred to as the leading group) is Zhangjiakou City, workers with major medical illnesses mutual aid activities of the leading organizations. The Leading Group is responsible for overseeing the collection, use and management of the city's employees' medical mutual aid for major illnesses, as well as studying, formulating and revising the methods, programs and rules of medical mutual aid activities for major illnesses.
Article 6 of the leading group set up under the Zhangjiakou City employees of major medical illnesses mutual aid activities service center (hereinafter referred to as mutual aid service center). Mutual aid service center is responsible for the day-to-day work of the major diseases medical mutual aid activities. The Mutual Aid Service Center is under the direct management of the Legal Protection Department of the Municipal Federation of Trade Unions.
Article 7 of the county federation of trade unions, the management area federation of trade unions, high-tech zone federation of trade unions, industrial trade unions to set up Zhangjiakou City, employees of major illnesses of medical mutual aid activities office (hereinafter referred to as the office), the office staff by the staff of the local trade unions, is responsible for the jurisdiction of the employees within the scope of the major illnesses of the medical mutual aid of the work of the specific matters.
Article 8: All directly subordinate grass-roots trade unions and the trade unions of foreign units residing in Zhangjiakou City shall set up representative offices for employees' mutual medical assistance activities for major illnesses. The representative office shall be equipped with full-time and part-time agents in accordance with the situation of each unit, and shall be responsible for the collection of the employees' mutual aid funds and the preliminary examination of the relevant information of the employees suffering from major illnesses, the declaration, and the collection and disbursement of the subsidies.
Chapter III Mutual Aid object scope and conditions
Article IX of the city's jurisdiction of the organs, enterprises, institutions, social organizations of the registered employees (excluding retired employees), and signed a labor contract or the formation of a de facto labor relations for more than a year of migrant workers, as long as the provisions of the payment of mutual aid, can be in the office, the office (unit of the trade union) unity of organization to participate in a group form of workers with major illnesses. All of them can participate in the employees' major illness medical mutual aid activities in the form of a group under the organization of the office or representative office (unit trade unions).
1, membership requirements: the activity does not accept individual membership, the number of participants in the group of more than 50 people must be no less than 85% of the number of registered employees in the unit; 50 people below the unit, the number of employees must be 100%.
2. Migrant workers are organized into groups by the trade unions (representative offices) of their employing units.
Article 10 Each unit group must provide the following materials when participating in the mutual aid activities:
1. Relevant labor statements that can accurately reflect the number of employees currently on the rolls of the unit;
2. "Zhangjiakou Municipal Employee Medical Mutual Aid for Critical Illnesses Group Application Form" electronic version of the information and print statements;
3. "Zhangjiakou Municipal Employee Medical Mutual Aid for Critical Illnesses Staff Roster" electronic version of the information and print statements;
3. Medical Mutual Aid Activity Personnel Roster" electronic version of the information and print the roster.
Article 11 Employees applying for participation in medical mutual aid activities must provide the following information:
1. A copy of their Chinese People's **** and National Resident Identity Card;
2. Employees participating in Zhangjiakou City's basic medical insurance are required to provide a copy of their own medical insurance card;
3. Those who are members of labor unions must provide a copy of their Labor Union Membership Card. copy.
Chapter 4: Financing and Management of Mutual Aid
Article 12: Sources of Mutual Aid:
1. Mutual Aid paid by individual employees;
2. Subsidies from the government, administration and labor unions;
3. Balance of Mutual Aid in the previous period;
4. Donations and sponsorships from all sectors of the society;
5. Interest and other income.
Article 13: Employees participating in the medical mutual aid activities must pay the mutual aid on a regular basis. Mutual aid contributions, once paid, will not be refunded. Each year is a period, the contribution standard is 36 yuan per person per year. Contributions in the year, eligible for major illness mutual aid activities, the right to apply for subsidies in that year. Each employee renews the contribution on an annual basis.
Mutual aid contributions are in principle paid by individual employees. If an employee in special hardship has difficulties in making personal contributions, the trade union of the unit may provide certain assistance from the funds retained by the trade union or from the funds for assisting employees in difficulty, and the trade union of the unit may also apply for a certain amount of subsidy from the administration.
Article 14: Mutual aid contributions paid by individual employees shall be collected by the labor union of each unit at the time of accepting the participation of employees in medical mutual aid activities.
Article 15: Employees' medical mutual aid for major illnesses adopts the operation mode of "citywide coordination, municipal control, hierarchical management, and multi-layer services". Each grass-roots trade union is responsible for collecting mutual aid funds from employees and submitting them to the municipal mutual aid service center in a graded manner. Mutual aid service centers set up special accounts for mutual aid, implement special fund management, and accept the supervision and review of the supervisory and review committees for mutual aid at the higher or local levels. Each office regularly accepts the supervision and audit of the relevant departments at the higher level.
Article 16 of the Municipal Mutual Aid Service Center uniformly withdraws 2% of the total amount of mutual aid paid by the employees as working expenses. At the same time, the grass-roots offices to give appropriate financial subsidies and equipment, the shortfall from the trade union funds transfer supplement.
Article 17: Mutual aid collected by the trade unions of each unit shall be submitted to the offices within a specified period of time, and the offices shall submit the funds to the municipal mutual aid activity service centers within a specified period of time. In order to prevent and reduce the risk of operating funds, the municipal service center after the co-ordination of the two phases of the allocation of the offices.
Article 18 of the offices in the mutual aid period, the unit occurred in the major diseases paid medical benefits according to the city unified regulations, the implementation of the hierarchy of approval authority, and reported to the municipal employees of the major illnesses of the Medical Mutual Aid Service Center for approval by the office to pay.
Article 19 of the employees of major medical illness mutual aid set up a special account management, earmarked for any organization or individual shall not be squeezed and misappropriated. If there are irregularities in the use of mutual aid subsidies in the process of operation, disciplinary use, the city service center will be deducted from the next tranche of the allocated advance. The subsidy advances allocated to each office shall be set up on the special account of the trade union assistance center; if there is no special account for the accounts of the assistance center for the time being, the account can be set up on the account of the trade union.
Article 20 Mutual Aid Service Centers are responsible for the collection, management and supervision of medical mutual aid, and the establishment of relevant management systems.
Article 21 Any employee who has not participated in the mutual aid activities for major illnesses shall not be entitled to medical aid and assistance.
Chapter V: Application and Payment of Mutual Aid
Article 22: Employees participating in mutual aid activities shall be hospitalized within the same period of time, and the individual out-of-pocket part of the medical expenses (expenses borne by individuals after reimbursement by the urban workers' and urban residents' basic medical insurance, as well as by the general medical insurance and the new type of rural cooperative medical insurance) shall be in accordance with the scope of the medicine and diagnosis and treatment catalogue of the basic medical insurance provided by the state and the province, and shall be paid in accordance with the out-of-pocket expenses. If the expenses incurred by an individual after being reimbursed by the workers' and urban residents' basic medical insurance and the new rural cooperative medical insurance are in line with the scope of the medication and treatment catalog of the basic medical insurance prescribed by the state and the province, the subsidy will be given proportionally according to the amount of the out-of-pocket payment calculated in segments.
Article 23: When an employee applies for a medical aid subsidy for a major disease, he/she shall go to the office by the representative office of his/her unit and provide the following information:
1. Employees participating in the basic health insurance shall provide the settlement statement of the medical expenses issued by the health insurance department (the original); and employees not participating in the basic health insurance shall provide the valid reimbursement vouchers of the local designated hospitals as determined by the Municipal Mutual Aid Service Center;
2, "Zhangjiakou City Employees' Major Disease Medical Mutual Aid Activity Mutual (Rescue) Aid Application and Approval Form";
3, a copy of the employee's ID card and labor union membership card;
4, the employee's Zhangjiakou City Employees' Major Disease Medical Mutual Aid Activity Card;
5, a certificate of discharge from the hospital;
6, diagnosis recommendation (or a diagnosis recommendation for a specific disease), or a diagnosis recommendation for a specific disease. Diagnostic Recommendation for Specific Diseases) or Referral Application Approval Form;
7. Other supporting information deemed necessary by the Municipal Mutual Aid Service Center and the Office.
Article 24 Types of Major Diseases:
1. Malignant tumors;
2. Chronic renal failure - dialysis treatment or kidney transplantation;
3. Aplastic anemia;
4. Acute myocardial infarction;
5. Heart valve replacement - open chest surgery;
6. surgery;
6. Post-stroke sequelae-permanent dysfunction;
7. Surgery for intracranial tumors-requiring craniotomy or radiation therapy;
8. Major organ transplantation-requiring xenotransplantation;
9. AIDS;
10.
10, Lupus erythematosus;
11, Post-encephalitis-permanent dysfunction (for minor children);
12, Aortic surgery-requires open thoracic or abdominal surgery (for minor children);
Additional Diseases:
13, Specific Chronic Diseases and General Diseases.
Article 25 Critical Disease Medical Mutual Aid Subsidies, Relief and Assistance Standards:
1. Sick employees whose personal out-of-pocket portion reaches 1,500 yuan (including 1,500 yuan) or more, or those who meet the following conditions can apply for employees' critical disease medical subsidies:
(1) suffering from a specific type of disease as determined by the health insurance department and the Municipal Mutual Aid Service Center in a designated hospital outpatient medical treatment;
(2) suffering from critical, emergency or serious illnesses in designated medical institutions or non-designated medical institutions in the event of an emergency, the treatment of which does not work and death;
(3) by the Municipal Health Insurance Department and the Municipal Mutual Aid Service Center for the record, the transfer of hospitals in a foreign country to seek medical treatment;
(4) relocation of personnel and work in foreign countries for long periods of time for official reasons in the Municipal Mutual Aid Service Center for the record of the hospitals medical treatment;
(5) hospitalization in an emergency hospital in a different place due to a critical, acute or serious illness during business trips, family visits or holidays away from home;
2. The individual portion of the hospitalization of a sick employee, once or cumulatively, shall be subsidized according to the following criteria, with a maximum limit of 30,000 yuan.
The subsidy is 23% of the individual portion up to 50,000 yuan (including 50,000 yuan).
A subsidy of 35% for the personal portion of over 50,000 yuan.
3. The scope of subsidies for general illnesses refers to the medical expenses incurred by employees who suffer from non-specific illnesses and are hospitalized in designated hospitals during the mutual aid period. Individuals who are responsible for more than 1500 yuan (including 1500 yuan) will be given a one-time subsidy at a rate of 23%, with a maximum payment limit of no more than 10,000 yuan.
4. 10% of the amount of subsidy will be added to the amount of subsidy for any labor union member suffering from a major disease.
5. Anyone who has paid mutual aid for five consecutive years (including those who have contributed for less than five years up to the age of retirement, may pay for five consecutive years), and who suffers from a major disease after retirement will still be given a one-time subsidy in accordance with the standard of mutual aid for major diseases of the registered employees.
6. Any employee who participates in the mutual aid for major illnesses and whose spouse (not working) or child (under 18 years old) has one of the major illnesses listed in this scheme can enjoy a one-time medical aid, with the standard of the aid being 10% of the individual's own part, and with the maximum payment limit not exceeding 5,000 yuan.
Article 26 In a mutual aid period, an employee suffering from a major disease may apply for mutual aid assistance one or more times, but the total amount of assistance shall not exceed the maximum payment limit.
Article 27 If an employee dies within the period of participating in the medical mutual aid activities for major diseases without incurring any medical expenses, his/her immediate family members can receive a one-time aid of 2,000 yuan.
Chapter VI Approval Authority and Management
1, the subsidy amount of less than 1,000 yuan by the office for approval, reported to the Municipal Mutual Aid Service Center for authorization, for the record;
2, the subsidy amount of more than 1,000 yuan by the office to declare, the director of the Municipal Mutual Aid Service Center for examination and approval, and reported to the chairman in charge of the review;
3, subsidy amount of 10,000 yuan or more by the office to declare. Municipal Mutual Aid Service Center for examination and approval by the chairman in charge of the Municipal Federation of Trade Unions, and reported to the executive chairman of the Municipal Federation for review;
4. The amount of subsidy of more than 20,000 yuan will be declared by the office, examined by the Municipal Mutual Aid Service Center, and examined and approved by the chairman in charge of the Municipal Federation of Trade Unions and the executive chairman, and reported to the chairman of the Municipal Federation of Trade Unions for review.
5. All cases of assistance are reviewed and approved by the Municipal Mutual Aid Service Center.
6. If mutual aid is paid by the municipal government, the approval procedure is carried out in accordance with the financial system of the municipal government.
Chapter VII exclusions
Article 28 of the following circumstances occur, the activity of no compensation (rescue) responsibility:
1, the use of various fraud, cheating fraudulent mutual aid subsidies or assistance;
2, work-related injuries, occupational diseases, maternity expenses;
3, fights, assaults, drug abuse, natural and man-made disasters, alcoholism, self-inflicted injuries, accidents and injuries incurred medical expenses;
4, the city's General Service Center, the city's General Service Center. Injuries incurred medical expenses;
4. Medical expenses arising from medical malpractice;
5. Other violations of laws and regulations.
Article 29: If an employee participating in the activities of medical mutual aid for major illnesses commits any of the behaviors referred to in Article 28, the employee's right to apply for mutual aid or assistance shall be immediately canceled, and the subsidies issued shall be recovered, and the responsible persons shall be held accountable for their actions.
Article 30: Employees who participate in medical mutual aid activities for major illnesses and who withdraw from basic medical insurance shall, from the date of withdrawal, be converted to mutual aid benefits without medical insurance provisions.
Article 31 to participate in the employees' major illnesses medical mutual aid units, medical institutions and employees have the right to report violations of these measures to the center, once verified, the whistleblower will be given appropriate incentives.
Article 32 The Municipal Mutual Aid Service Center will entrust the medical insurance inspection department of the Municipal Social Insurance Administration to inspect and verify the medical expenses incurred by the employees in the designated medical institutions, and if any violation is found to have occurred, it will be punished in accordance with the penalty provisions of the medical insurance department.
Chapter VIII Supplementary Provisions
Article 33 If an employee who participates in the employee's medical mutual aid activities for major illnesses is transferred within a mutual aid period, the transferring and transferring units shall notify the office within 30 days, and the office shall transfer and renew the relationship of the employee's mutual aid for the employee and report it to the Mutual Aid Service Center for the record.
Article 34: If an employee participating in mutual aid activities is hospitalized for a period of time spanning two mutual aid periods and continues to pay the next period of mutual aid, the standard of subsidy shall not be affected by the span of time. The time limit for the subsidy can be traced back to the starting date of the previous period, and the expenses incurred before the starting date will not be subsidized; if the employee does not continue to pay the next period of mutual aid, the subsidy will only be given for the medical expenses incurred in the previous period of mutual aid.
Article 35: In order to further expand the subsidies for sick workers, make the use of mutual aid more flexible, and benefit more workers, the Medical Mutual Aid Service Center may, according to the use of mutual aid in the current period, report to the Municipal General Chairman's Office for approval and carry out the following activities at its own discretion:
1. For the workers who hold the "Special Difficulty Employee Family Preferential Treatments Certificate" in the current year, and who are suffering from chronic illnesses that are controlled by medicines, the following activities shall be carried out at its discretion Special hardship workers who are under control will be given a one-time flat-rate subsidy as appropriate.
2. For some workers suffering from major diseases whose personal burden of expenses is still huge after the subsidy, resulting in special difficulties for their families, a one-time flat-rate medical aid will be given as appropriate.
3. Employee medical assistance wards are set up in designated hospitals to provide medical assistance to workers in difficulty who are genuinely unable to pay for their medical expenses by means of medical assistance.
Article 36 of the Zhangjiakou City employees to participate in the activities of workers in major illnesses and medical assistance, while enjoying the Hebei Provincial Federation of Trade Unions in the year provided by the Hebei Provincial Trade Union members of non-work-related accidents and family property (fire) damage free protection.
Article 37: The annual mutual aid subsidy period is 365 days, and the first 30 days of the subsidy period is the payment period for the mutual aid fund.
Article 38 of the implementation of this approach for the period from April 20, 2011 to April 20, 2012.
Article 39 of these measures by the Zhangjiakou City employees major illnesses medical mutual aid activities service center is responsible for interpretation.
Expanded reading: insurance how to buy, which is good, hand to teach you to avoid the insurance of these "pit"