(a) basic medical insurance premium contribution standard
1, the employer unit to participate in the insurance:
Unit to pay 8% of the contribution base, the individual employee to pay 2% of the contribution base, by the participating unit withholding payment.
2. Participation as an individual: 10% of the contribution base.
(2) Hospitalization medical insurance premiums: 5.5% of the contribution base is paid by the insured unit or the insured individual.
(3) The mutual medical insurance premiums for major illnesses are the same as the contribution base of the basic medical insurance, and are paid at 1%, of which 0.5% is paid by the employer and 0.5% is paid by the individual.
(d) Basic and hospitalization medical insurance personnel must have completed more than 15 years of continuous contributions before retirement, less than 15 years, must make up the contributions.
(e) urban residents medical insurance contribution standards: urban elderly residents (male 60 years old, female 50 years old and above) individual payment of 120 yuan; urban young and middle-aged non-employee residents (18 years old and above, male 59 years old, female 49 years old and below), individual payment of 180 yuan.
(f) Children and youth supplementary medical insurance contribution standard: individual payment of 40 yuan.
(vii) employers pay monthly, basic health insurance individuals between late December each year to March of the following year, residents between October and December 20 each year, children in September each year between 1 and 20 of the month to pay the next year's health insurance premiums, the responsibility for late payment.
Two, individual accounts
Individual accounts are divided into: fixed accounts and monthly accounts
Participation in the basic medical insurance fixed account for employees: according to the minimum monthly contribution base of 2,299 yuan and the lowest grade of the account transfer ratio of 3.5% calculated and rounded to the nearest whole number for the month of 80 yuan, 960 yuan for the whole year, after deducting the supplemental health insurance premiums of 60 yuan the whole year is actually 900 yuan, the beginning of the year, a transfer. The actual amount for the whole year is 900 yuan, which will be transferred at the beginning of the year. The difference (i.e., the monthly account) will be calculated and transferred according to the actual contribution base per person after the monthly payment of medical insurance premiums.
The formula for calculating the monthly account: monthly contribution base×corresponding ratio-monthly fixed account.
Corresponding ratio: 3.5% for those under 35 years old, 4.5% for those 36-45 years old, and 5.5% for those over 46 years old, of which: if the monthly contribution base is greater than 4,306 yuan, the above ratio will be increased by another 0.5 percentage points.
Basic medical insurance 70 years of age (including 70 years of age) above the actual monthly transfer of 87.5 yuan retirees, of which: fixed account 67.5 yuan, 20 yuan monthly account. The annual fixed account of 810 yuan, once at the beginning of the year, the monthly account for the whole year totaled 240 yuan, the total annual total of 1,050 yuan.Retirees under the age of 70 years old are actually transferred 85 yuan per month, of which: 65 yuan for the fixed account and 20 yuan for the monthly account. The fixed account of $780 for the year is transferred in one lump sum at the beginning of the year, and the monthly account totals $240 for the year, for a total of $1,020 for the year.
Retiree low-level health insurance (medical care) individual account of 300 yuan per person per year, the resident health insurance individual account of 90 yuan per person per year.
Third, the original chronic disease special disease special outpatient treatment
Fixed account (hospitalization insurance 600 yuan) used up, participate in the basic (inpatient) medical insurance personnel to enjoy the chronic disease special disease special outpatient treatment out-of-pocket segment standards for 600 yuan. Limit standard: 2,000 yuan for one chronic disease, 4,000 yuan for two or more chronic diseases, reimbursement ratio of 50% for active staff and 75% for retirees. Ambulatory malignant tumor outpatient radiotherapy limit of 4,000 yuan, reimbursement rate of 60% of active staff, retirees 80%.
From 2011 onwards, there will be no more chronic disease declaration, and the establishment of outpatient co-ordination system. That is: personal account (or equivalent personal account) is used up, the individual again after the burden of 600 yuan, still need to visit the hospital for treatment, please in the People's Hospital, Hospital of Traditional Chinese Medicine, the second hospital, three hospitals, four hospitals, Bingfang, Tho Town, Fengli, Shuangdian, Mathang hospitals and settlement. Calculated for the whole year, within 3,000 yuan, 60% will be reimbursed for active employees and 80% for retirees. Medical insurance centers do not accept sporadic reimbursement for such business.
Fourth, medical insurance hospitalization starting line
The starting line for special tertiary medical institutions outside the county is 1,000 yuan, the county people's hospital and hospital of traditional Chinese medicine is 600 yuan, and other hospitals in the county is 500 yuan, and children and teenagers are reduced on the basis of the above standards by 300, 100, 100 yuan respectively. For multiple hospitalizations within a year, the threshold is reduced by 20% on top of the above standards, with a minimum of 200 RMB. In the process of transferring to a hospital for continuous treatment, the starting payment line is calculated according to the standard of the higher-level medical institution. For long-term continuous hospitalization and multiple hospitalization of malignant tumor patients within one year for radiotherapy, the hospitalization starting line is calculated every 90 days.
V. Segmental reimbursement ratio of hospitalized medical expenses
Expense segments Basic (hospitalization) insurance Expense segments Juvenile and children
Medical insurance Urban and rural residents and retirees with low level of medical insurance In-service Retirement Basic 0-10,000 yuan 88% 92% 0-0.5 million yuan 65% 75% 1-100,000 yuan 93% 97% 0.5-100,000 yuan 75% Major diseases 10 -200,000 yuan 90% 100,000-120,000 yuan 80% 200,000-300,000 yuan 95% ----- ----- ----- Sixth, the norms of medical treatment of the insured personnel V. Hospitalization medical expenses reimbursement ratio in segments
1, the insured personnel must be in their designated medical institutions headquarters with their medical insurance card, the doctor who treats the patient in accordance with the relevant provisions of the administrative department of health and timely writing of medical records. Expenses that are not recorded in the medical insurance card's medical history and treatment, and expenses for medical treatment without using the social insurance card (IC card) (except for equipment failure and emergency treatment), will not be included in the settlement.
2. If a participant is hospitalized within the county due to illness: he/she should go to the inpatient charging office with the Admission Notice issued by the doctor and his/her social security card (IC card), and hand in the social security card (IC card) to the charging office of the hospital, which will be used to record the daily medical expenses. When discharged from the hospital, the expenses that should be paid by the integrated fund will be settled by the designated medical institution with the medical insurance center on a monthly basis. Expenses proportionally borne by individuals and expenses not covered by reimbursement shall be settled by individuals in cash.
3. If you are approved to be transferred to a hospital outside the county, you must go to the People's Hospital, Hospital of Traditional Chinese Medicine and center-level hospitals in the county to go through the procedures of transferring to a hospital, and the employer or the neighborhood committee will sign the opinion and report it to the medical insurance center for examination and filing. The hospital must be a hospital contracted by the county medical insurance. Namely: Shanghai: Zhongshan, Huashan, Ruijin, Changzheng, Changhai, Dongfang Hepatobiliary, City Oncology, Chest Hospital, Ninth People's Hospital; Nanjing: Provincial People's Hospital, Gulou, Provincial Oncology, General Hospital of the Nanjing Military Command, Provincial Hospital of Traditional Chinese Medicine, CU Hospital, Institute of Skin Diseases; Nantong: Tongda Hospital, City Hospital, City Hospital of Traditional Chinese Medicine, Tumor Hospital, Tongji Hospital, City Hospital, City Hospital of the Third, City Hospital, City Hospital of the Sixth, Rui Ci Hospital; Suzhou: Jiangsu Medical University Hospital Hematology Specialty. The hematology specialty of the hospital. Children and adolescents outside the county special hospitals in addition to Nantong City, Nanjing City and Shanghai Children's Hospital and Maternal and Child Health Center.
4, the settlement of the transfer of overseas treatment costs need to provide: official computer bills supervised by the financial and taxation departments, outpatient prescriptions, medical records, hospital discharge records (summary), hospitalization fees list, social security card (IC card), application form for transfer to the hospital (school certificate), ID card. Those who are enrolled in the Children's Insurance are also required to provide receipts of premiums, school certificates, and household registers. Fees for treatment outside the country are required to be settled in the current year (fees incurred in December must be settled in January of the following year).
5, outpatient radiotherapy for malignant tumors, severe chronic renal insufficiency, hyperthyroidism, hypothyroidism, rheumatoid arthritis, aplastic anemia, lupus erythematosus, ankylosing spondylitis, and Parkinson's syndrome patients should go to designated hospitals to purchase medicines, or else they will not be reimbursed.
Medicare center friendly reminder:
Social health insurance can not be repeated enrollment; social health insurance and the new rural cooperative medical care, can not be repeated.
The county clinic settlement please use the social security card (IC card), the medical insurance center does not accept the card medical expenses; transfer outside the see a doctor please go to the medical insurance hospitals, and please hold a regular and valid computer bills and other information to reimbursement, the medical insurance center does not accept handwritten bills.