Decree of Chengdu Municipal People's Government
Number l54
The measures for the basic medical insurance for urban workers in Chengdu have been discussed and passed at the 22nd executive meeting of the municipal government on June 3, 2008, and are hereby promulgated and shall come into force as of June 38, 2009.
Mayor of Ge Honglin
November 18th, 2008
Official Reply of Chengdu Labor and Social Security Bureau on Relevant Issues Concerning the Implementation of the Municipal Government's Orders 154 and 155
Cheng Lao She Han [2009] No.40
Chengdu Medical Insurance Administration:
Your request for instructions on issues related to the implementation of municipal government orders has been received 154 and no 155 (Cheng Yibao [2009] No.9). The answer to your question is as follows:
The first part is the basic medical insurance for urban workers in Chengdu.
First, the "measures" referred to in Article 6 of the individual insured, including individual industrial and commercial households without employees, freelancers, flexible employees and other personnel who participate in the basic medical insurance for urban workers in their personal capacity according to the provisions of the provincial and municipal government documents.
Two, the "measures" in the sixth paragraph of article tenth "within 3 days before admission" refers to the first 3 days of hospitalization procedures. For example, Li went through the admission formalities on the 5th, and during the period from the 2nd to the 5th, the outpatient positive special examination fee (based on the time recorded in the invoice) occurred in the hospital that went through the admission formalities was included in the overall fund reimbursement.
3. "Special examination" in Paragraph 6 of Article 10 of the Measures refers to X-ray photographs, magnetic resonance scanning (MRI), X-ray computed tomography (CT), color Doppler ultrasound examination, gamma photography, single photon emission computed tomography (SPECT), detection of residual focus of leukemia, determination of tumor-related antigen, dynamic electrocardiogram, dynamic electroencephalogram, and fibrobronchus.
4. Paragraph 2 of Article 13 of the Measures, "single unit price 1 000 yuan or more for operation", only refers to the operation project itself, excluding anesthesia, materials, nursing, monitoring and other related expenses.
Five, the "measures" in the first paragraph of Article 16 of the continuous payment, refers to before 2009 1, has been in the unit and individual industrial and commercial households with employees to participate in the city's basic medical insurance, from 2009 1 shall not be interrupted to pay the basic medical insurance premium. If there is any interruption, it shall be handled in accordance with the provisions of Article 18 of the Measures.
Six, the "measures" in the second paragraph of article sixteenth of the expression "to participate in the basic medical insurance for urban workers as an individual" refers to the termination of labor relations with the original unit, should continue to participate in medical insurance as an individual within 4 months. Uninterrupted payment time refers to those who left their jobs 200 1 year 1 year ago due to bankruptcy, restructuring or institutional reform, and pay the basic medical insurance premium continuously from 200 1 year to the legal retirement age; After 200 1, 1, 1, if he leaves the company due to bankruptcy, restructuring, institutional reform, etc., he shall continue to pay the basic medical insurance premium from the date of termination of labor relations with the company to the legal retirement age, and shall pay it back if there is any interruption.
Seven, after 2009 10/0/day, the non-agricultural population registered in the administrative area of Chengdu due to land acquisition, the time limit for the land acquisition department to pay the basic medical insurance premium in one lump sum, and the payment time is calculated forward from the date of approval of the land acquisition compensation and resettlement plan. If the calculation time is before 2009 1 month, it shall be deemed as insured before the implementation of these measures, and vice versa. Example: In 20 16, Zhang's land was expropriated according to law and registered as a non-agricultural population, and the land acquisition department paid the basic medical insurance premium 10, that is, 2016-/kloc-0 = 2006. Zhang was insured before the implementation of the Measures.
Eight, in order to ensure that the outpatient medical treatment of retirees in our city is not reduced, it is decided to suspend the implementation of the provisions of Article 8 of these rules. From June 65438+1 October1in 2009, the transfer and connection of personal accounts of retirees' medical insurance in this city was strictly implemented in accordance with the provisions of the municipal government decree 154. When institutions declare individual accounts of retirees, they need to provide a retirement pension approval form signed by the Personnel Bureau. Pension relationship in the province, the need to provide proof of retirement pension payment confirmed by the provincial social security agencies.
Nine, mental illness for the first time to apply for outpatient special diseases, it is necessary to provide the disease diagnosis certificate issued by the psychiatric hospital designated by the basic medical insurance in this Municipality or the psychiatric department of the second-level general hospital.
Ten, the insured medical treatment in different places, the hospitalization expenses in this city can be reimbursed in the overall fund according to the regulations.
Eleven, the convergence of medical insurance for dependents according to the provisions of article nineteenth of the "measures".
The second part is the basic medical insurance for urban and rural residents in Chengdu.
First, the medical expenses for work-related injuries incurred by urban and rural residents who go out to work shall be implemented in accordance with the relevant provisions of the Regulations on Work-related Injury Insurance. The medical expenses incurred in infertility treatment do not belong to the scope of reimbursement of basic medical insurance, and the basic medical insurance fund for urban and rural residents will not pay.
2. Urban and rural residents who have participated in supplementary medical insurance in this city before 2009 1 and the insurance relationship has not been interrupted can continue to participate in supplementary medical insurance according to regulations; Urban and rural residents who have not participated in the supplementary medical insurance since June 65438+1 October12009 have suspended the purchase of supplementary medical insurance.
Three. Hospital preparations approved by Chengdu Labor and Social Security Bureau to be included in the reimbursement scope of basic medical insurance are applicable to all clients within the medical insurance business scope of our hospital.
Four, to participate in the basic medical insurance for urban and rural residents, birth complications occurred during childbirth, hospitalization expenses according to the provisions of the basic medical insurance for urban and rural residents, in the overall fund according to the provisions of reimbursement.
5. According to the order of Chengdu Municipal People's Government 134, urban residents can be transferred to the basic medical insurance for urban employees, and the payment years are calculated together; Can also be transferred to the basic medical insurance for urban and rural residents. If the treatment is effective after June 65438+1 October1,the validity period will be extended to June 65438+February 3, 2009/. Reimbursement benefits in accordance with the "Interim Measures for the basic medical insurance for urban and rural residents in Chengdu" thirteenth third file to enjoy medical insurance benefits, but do not enjoy outpatient subsidies.
Six, the city's household registration to participate in the basic medical insurance for urban and rural residents in primary and secondary school students, during the winter and summer vacations, the hospitalization expenses occurred in the local basic medical insurance designated medical institutions, included in the basic medical insurance fund for urban and rural residents.
Seven, newborn babies can participate in the basic medical insurance for urban and rural residents in this city, but not limited by the full moon.
April 2009 15