Chengdu Municipal People's Government Order
No. 154
"Chengdu Urban Employees Basic Medical Insurance Measures" was issued by the municipal government on November 3, 2008. It was discussed and adopted at the executive meeting and is now announced and will come into effect on January 1, 2009.
Mayor Ge Honglin
November 18, 2008
Chengdu Municipal Labor and Social Security Bureau on the Implementation of Municipal Government Orders 154 and 155 Reply to relevant issues
Chengdu Labor Society Letter [2009] No. 40
Chengdu Municipal Medical Insurance Administration:
Your Bureau's "About Implementation of Municipal Government Orders" Request for Instructions on Relevant Issues No. 154 and 155 (Chengyibao [2009] No. 9) received. In response to the questions you have raised, after research, the answers are as follows:
Part 1 Chengdu Basic Medical Insurance for Urban Employees
1. Individual insurance as referred to in Article 6 of the "Measures" Personnel, including self-employed individuals, freelancers, flexible employment personnel and other personnel who participate in the urban employee basic medical insurance as individuals in accordance with provincial and municipal government documents.
2. "Within 3 days before admission" in Article 10, Paragraph 6 of the "Measures" refers to the 3 days before hospitalization procedures are completed. For example: Li went through admission procedures on the 5th. During the period from the 2nd to the 5th, the outpatient positive special examination fees incurred at the hospital where the admission procedures were performed (based on the time recorded on the invoice) will be included in the overall fund for reimbursement.
3. "Special examinations" in paragraph 6 of Article 10 of the "Measures" refer to X-ray imaging, magnetic resonance imaging (MRI), and X-ray computed tomography that are within the payment scope of basic medical insurance. Scanning (CT), color Doppler ultrasonography, gamma photography, single photon emission computed tomography (SPECT), detection of residual leukemia lesions, determination of tumor-related antigens, dynamic electrocardiography, dynamic electroencephalography, fiberoptic bronchoscopy, Gastroscopy, colonoscopy, histopathological examination and diagnosis, fiber bronchoscopy anti-contamination sampling brush examination and other diagnostic and treatment equipment inspections.
4. Item 2 of Article 13 of the "Measures" "Surgery fees for a single item with a price of more than 1,000 yuan" only refers to the surgical item itself, and does not include anesthesia, materials, nursing, monitoring and other related expenses.
5. The continuous and uninterrupted payment stipulated in the first paragraph of Article 16 of the "Measures" refers to those who have participated in the city's basic medical care in units and individual industrial and commercial households with employees before January 2009. People with insurance must pay basic medical insurance premiums without interruption starting from January 1, 2009. If there is any interruption, it will be handled according to the provisions of Article 18 of the "Measures".
6. "Continuous and uninterrupted participation in the basic medical insurance for urban employees as an individual" stated in the second paragraph of Article 16 of the "Measures" means that after the labor relationship with the original unit is terminated, the employer shall Continuing medical insurance as an individual within the month. The period of continuous uninterrupted payment refers to those who left the unit due to bankruptcy, restructuring or organizational reform before January 1, 2001, who will continue to pay basic medical insurance premiums from January 1, 2001 until they reach the statutory retirement age; in 2001 Personnel who leave the unit due to bankruptcy, restructuring or organizational reform after January 1 shall continue to pay basic medical insurance premiums from the date of termination of the labor relationship with the unit until they reach the statutory retirement age. If there is any interruption, they shall make additional payments.
7. After January 1, 2009, for persons whose land has been requisitioned in accordance with the law in the administrative area of ??Chengdu City and whose non-agricultural population registration has been carried out, the land acquisition department shall pay the basic medical insurance premiums at one time for a period of years and payment time. Calculated from the date of approval of the land acquisition compensation and resettlement plan. If the calculated time is before January 2009, it will be deemed as insured before the implementation of these measures, otherwise, it will be deemed as insured after the implementation of these measures. Example: Zhang’s land was requisitioned according to law in 2016 and non-agricultural population registration was carried out. The land acquisition department paid basic medical insurance premiums for him in one lump sum for 10 years, that is, 2016-10 = 2006. Zhang was insured before the implementation of this Measures. .
8. In order to ensure that the outpatient medical benefits of retirees in our city are not reduced, it has been decided after study that the provisions of Article 8 of the "Implementation Rules" will be suspended. Starting from January 1, 2009, the transfer of personal medical insurance accounts for retirees in this city will be made in strict accordance with the provisions of the Municipal Government Order No. 154.
When agencies and institutions declare the personal account funds of retirees, they must provide the retiree pension approval form signed by the Personnel Bureau. If the pension relationship is with the province, they must provide the retiree pension payment confirmed by the provincial social security department. prove.
9. If you apply for special outpatient services for the first time due to mental illness, you must provide a disease diagnosis certificate issued by the psychiatric hospital designated by the city’s basic medical insurance or the psychiatric department of a general hospital with grade A or above.
10. For insured persons who have gone to other places for medical treatment, the hospitalization medical expenses incurred in this city can be reimbursed in the overall fund according to regulations.
11. The connection of medical insurance for military dependents shall be handled in accordance with Article 19 of the "Measures".
Part 2 Chengdu Basic Medical Insurance for Urban and Rural Residents
1. Medical expenses incurred by urban and rural residents injured at work due to work-related injuries shall be governed by the relevant provisions of the "Regulations on Work-related Injury Insurance". Medical expenses incurred for infertility treatment are not covered by the basic medical insurance and will not be paid by the basic medical insurance fund for urban and rural residents.
2. Urban and rural residents who have participated in the city’s supplementary medical insurance before January 1, 2009 and whose insurance relationship has not been interrupted can continue to participate in the supplementary medical insurance in accordance with regulations; those who have not participated after January 1, 2009 Urban and rural residents with supplementary medical insurance in this city are suspended from purchasing supplementary medical insurance.
3. Hospital preparations approved by the Chengdu Municipal Labor and Social Security Bureau to be included in the reimbursement scope of basic medical insurance are applicable to all service objects within the medical insurance business scope of the hospital.
4. For those who participate in the basic medical insurance for urban and rural residents, the hospitalization medical expenses for birth complications that occur during childbirth shall be reimbursed in the fund in accordance with the provisions of the basic medical insurance for urban and rural residents.
5. Urban residents insured according to Chengdu Municipal People’s Government Order No. 134 can be transferred to the Urban Employee Basic Medical Insurance, and the payment years are combined; they can also be transferred to the Urban and Rural Resident Basic Medical Insurance. If the benefit is valid after January 1, 2009, the validity period will be extended to December 31, 2009. Reimbursement benefits are based on the third level of Article 13 of the "Chengdu Urban and Rural Residents Basic Medical Insurance Interim Measures", but do not enjoy outpatient subsidies.
6. For primary, secondary and primary school students who are not registered in this city and participate in this city’s basic medical insurance for urban and rural residents, the hospitalization medical expenses incurred in the local basic medical insurance designated medical institutions during the winter and summer vacations will be included in the urban and rural areas. Reimbursement from the Resident Basic Medical Insurance Fund.
7. New-born babies can participate in the city’s basic medical insurance for urban and rural residents as soon as they register in the household, and they are not subject to the one-month restriction.
April 15, 2009