(a) transfer standards:
Employee health insurance personal account transferred on a monthly basis, the age of the insured person is less than 45 years old, according to the base of my monthly contributions to 3%; 45 years old according to the base of my monthly contributions to 4%; retired (retired) personnel according to the base of their pensions of 4.5% into the.
(2) scope of use:
Personal accounts are mainly used to pay for general outpatient medical expenses, the cost of purchasing medicines and hospitalization medical expenses borne by the individual. Meanwhile, according to the "Notice on Adjusting the Scope of Payment of Individual Accounts of Zhengzhou City Urban Employees' Basic Medical Insurance" (Zheng Renminsha Medical [] No. 13), the individual account can also be used within the following scope:
1. For payment of medical expenses incurred by myself and my designee for outpatient medical treatment at a designated medical institution (excluding outpatient prescribed illnesses, outpatient serious and serious illnesses, and outpatient co-ordination), or for expenses incurred for purchasing medicines at a designated retail pharmacy. retail pharmacies.
2. It is used to pay for the medical expenses borne by the individual who is hospitalized.
3. It is used to pay for the retiree's commercial supplementary medical insurance premiums.
4. It is used to pay for the costs of purchasing and injecting vaccines for disease prevention at designated medical institutions for the retiree and his/her designee.
5. It is used to pay for the medical expenses incurred for health checkups, prosthetic limbs, eyes and other artificial prostheses, and treatment of dental diseases at designated medical institutions.
6. It is used to pay for the expenses incurred by the individual and his/her designee for the purchase of food and health-registered health food products, anti-personnel supplies approved by the health department, household medical (health) equipment and medical consumables at designated retail pharmacies.
The principal and interest of the individual account are owned by the insured person, and can be carried forward and inherited, but cannot be withdrawn in cash or used for other purposes.
Legal basis:
Hefei Basic Medical Insurance Measures
Article 1 In order to standardize the basic medical insurance treatment, to protect the legitimate rights and interests of the participants, according to the "Hefei Basic Medical Insurance Measures" (Hefei Municipal Government Decree No. 213) and other relevant provisions, to formulate the rules.
Second, these rules apply to the city's employees basic medical insurance, employee maternity insurance, urban and rural residents basic medical insurance participants, contributions, treatment protection and service management.
Article 3 The expenses within the scope of the policy referred to in these rules refer to the medical expenses in accordance with the national and provincial catalogs of medicines and medical services for basic medical insurance. The starting standard refers to the medical expenses within the scope of the policy that are paid by the individual before the medical insurance fund. The prepaid expenses refer to a certain percentage of out-of-pocket expenses to be paid by an individual when the insured person uses Class B drugs, nationally negotiated drugs, and medical consumables that can be charged separately. The payment ratio refers to the proportion of medical expenses within the scope of the policy paid by the medical insurance fund after deducting the starting standard and the prepaid expenses.
Article 4 The insured employees shall go to the medical insurance agency for the review of the employees' medical insurance contribution period when they reach the legal retirement age or when they retire. If the contribution period is insufficient, the insured person shall make up the contribution according to the regulations, and enjoy the employee medical insurance treatment from the next day of making up the contribution.
Retirees who retire in the city and receive monthly basic pensions and are not covered by the employee medical insurance may voluntarily apply to the local medical insurance agency for retroactive contributions, and will be entitled to the employee medical insurance benefits from the day after the retroactive contributions are made.
Article 5: All employee health insurance premiums paid by individual workers at a rate of 2% shall be transferred to their personal accounts. Retirees' personal accounts are transferred to the integrated fund at a fixed monthly rate, 150 yuan/month in 2022, and adjusted accordingly in the future in accordance with national and provincial regulations.
Participants transfer out of the medical insurance relationship, go abroad (territory) settlement cancellation of domicile, death and other circumstances, should be in accordance with the provisions of the transfer, liquidation of personal accounts. In the event of the death of a participant, the heir or legatee shall go to the health insurance agency for the liquidation of the individual account.
Article 6: When an insured person incurs general outpatient (including emergency) medical expenses within the scope of the policy, the integrated fund shall pay for them according to the following provisions:
(1) For the general outpatient expenses incurred by an active employee at the designated medical institution for outpatient coordination for employees in the city, the starting standard of the medical insurance fund for the year is 1,000 yuan, and the limit of payment is 4,000 yuan, which shall be paid to the insured person in the community health service center (township health center. Hereinafter referred to as primary medical institutions), city (county) level and other medical institutions, provincial medical institutions, general outpatient payment ratio of 60%, 55%, 50%; retirees annual starting standard of 800 yuan, payment limit of 5,000 yuan, and all levels of medical institutions, respectively, to increase the payment ratio of 5 percentage points.
(2) The cost of purchasing medicines with outpatient prescription incurred at designated retail pharmacies through the prescription flow platform can be included in the fund's payment, and the payment ratio will be implemented at 55%.
(3) General outpatient expenses incurred during the hospitalization of insured persons, outpatient expenses for chronic and special diseases (hereinafter referred to as chronic and special diseases), maternity outpatient maternity expenses, as well as health checkups, vaccinations and other expenses not covered by the basic medical insurance shall not be paid by the general outpatient co-ordination fund, and shall not be counted as part of the accumulation of the general outpatient expenses.
(4) General outpatient medical expenses are not included in the scope of payment by the major disease insurance and medical aid funds.
Article 7: Insured workers suffering from slow and special outpatient diseases stipulated by the city may apply for slow and special outpatient treatment from the medical insurance agency. Individual out-of-pocket expenses after reimbursement in accordance with the city's outpatient treatment for slow and special diseases will not be included in the cumulative range of general outpatient expenses. The specific measures will be separately formulated by the city's medical insurance department.
Article VIII of the insured in the designated medical institutions hospitalization medical costs within the scope of the policy, the integrated fund shall pay in accordance with the following provisions:
The city's first-class and the following (including township health centers, community health service centers, hereinafter the same), second-class, third-class medical institutions, the fund starting standard of 200 yuan, 400 yuan, 600 yuan respectively; hospitalized twice in a year and above, from If hospitalized twice or more in one year, the starting payment standard of the fund will be reduced by half from the second hospitalization. The payment ratio of first and lower, second and third level medical institutions are 94%, 92% and 90% respectively; the payment ratio of the fund for retirees in first, second and third level medical institutions are 97%, 96% and 95% respectively.