Urban residents' medical insurance is a medical insurance system with urban minors and unemployed residents who have not participated in urban workers' medical insurance as the main participants. It is an important measure for the CPC Central Committee and the State Council to further solve the medical security problems of the broad masses of people and continuously improve the medical security system after implementing the basic medical insurance system for urban workers and the new rural cooperative medical system. Mainly to make institutional arrangements for medical insurance for urban non-employed residents. The appearance of this system is of great significance in the process of social insurance system reform in China, which points out the direction for the reform of social insurance system in China.
From 65438 to 0998, China began to establish the basic medical insurance system for urban workers. In order to achieve the goal of basically establishing a medical security system covering urban and rural residents, the State Council decided to start the pilot project of basic medical insurance for urban residents in 2007.
Processing method editor
Specifically, it includes four items. If the applicant needs to provide complete information, it will be handled immediately; If the information is incomplete, it will not be accepted for the time being, and the applicant shall be informed of what information needs to be supplemented. Details are as follows:
(a), the application for insurance (increase) notice
1, provide information (the following information should be attached with the original and copy of A4 paper):
①/kloc-persons under 0/8 years old: household registration book (all members' information in the household registration book must be copied) and ID card (/kloc-persons under 0/6 years old who do not have an ID card need not provide it).
② 18 or above students who are still studying in full-time schools: household registration book (all members' information in the household registration book needs to be copied), ID card, and student status certificate issued by their school.
③/kloc-Unemployed urban residents over 0/8 years old: household registration book (all members' information of household registration book must be copied); Identity Card (Demobilized soldiers need to provide proof of retirement or job transfer).
(4) Minimum living allowance: household registration book, ID card, and minimum living allowance certificate for urban and rural residents (villages) in Guangdong Province.
2. Processing flow:
Handling department: ① Urban residents living in the sub-district offices of Qiaoxi, Qiaodong, Jiangnan, Jiangbei, Longfeng and He 'nan 'an in Huicheng District go to the Relations Unit of Huicheng Social Security Bureau for handling; ② Urban residents living in the county town, Danshui Sub-district Office of Huiyang District and Aotou Sub-district Office of Daya Bay District shall go to the local social security bureau for handling; ③ Urban residents living in other counties (districts) and towns (street offices) shall go to the local labor security management office or social security bureau for handling.
After the business is completed, the handling personnel will print the "Checklist of Basic Medical Insurance for Urban Residents in Huizhou" and hand it over to the applicant on the spot. If the applicant finds any mistakes or omissions, he must go to the handling department to correct them within five working days. If it is not handled within the time limit, it shall be regarded as error-free.
The business acceptance time is 1-24 every month, and the business declared in that month will take effect from the following month. July 1 day of that year to June 30th of the following year is a social security year, and the medical insurance premium of one social security year is paid in one lump sum, and the medical insurance premium of the next social security year is paid in one lump sum from June 1 day to 30th of each year.
(2), the winning stop insurance (attrition) notice
1, provide information (the following information shall be original A4 paper and its copy):
① Employment: Sign a labor contract with the certificate of the employer.
② Exit: With the passport and ID card of the People's Republic of China.
③ Death: with death certificate or valid certificate of local police station and ID card.
2. Processing flow:
Handling department: go to the social security bureau related unit or labor security office where the insured person is located.
Fill in the Form: Application Form for Increase (Decrease) of Basic Medical Insurance for Urban Residents in Huizhou City in duplicate.
After the business is completed, the handling personnel will print the Checklist for Reduction of Staff in Huizhou Basic Medical Insurance for Urban Residents and hand it over to the applicant on the spot. If the applicant finds any mistakes or omissions, please go to the handling department to correct them within five working days. If it is not handled within the time limit, it shall be regarded as error-free.
The business declared before 25th of the current month will take effect from the following month, and the paid medical insurance premium will not be refunded.
(3), bidding information change notice
1, provide information (the following information should be attached with the original and copy of A4 paper):
① Change of the name or ID card of the head of household: with the household registration book and ID card.
② Change of the name or identity card of the insured: with the identity card.
③ Change of household registration address, contact telephone number and other relevant information: the household registration book or application form and other relevant information shall prevail.
④ Change of payment standard:/kloc-Students over 0/8 years old who are still studying in full-time schools shall be certified by their schools.
2. Processing flow:
Handling department: go to the social security bureau related unit or labor security office where the insured person is located.
Fill in the form: Huizhou urban residents' insurance information correction checklist in duplicate.
After the business is completed, the handling personnel will print the "Huizhou Urban Residents' Insurance Information Correction Checklist" and hand it to the applicant on the spot. If there is any mistake or omission, please go to the handling department to correct it within five working days. If it is not handled within the time limit, it shall be regarded as error-free.
(four), the application for insurance information printing, consulting, inquiry instructions.
1. Print: Go to the related unit of the Social Security Bureau or the labor security office of the insured place with the ID card of the head of household, and print the insurance information of the previous year in July every year.
2, consultation, inquiry: with the insured's "ID card" to the local social security bureau or labor security office.
(5), matters needing attention
If the information provided by the applicant is complete, it shall be handled immediately; If the information is incomplete, it will not be accepted for the time being, and the applicant shall be informed of what information needs to be supplemented.
Major difference editing
Difference from employee medical insurance
First, face different people. Medical insurance for urban workers is mainly for employees and retirees who have work units or are engaged in individual economy. Medical insurance for urban residents is mainly for urban non-employees such as elderly residents, low-income objects, severely disabled people, students and children who have urban household registration and have no jobs;
Second, the payment standards and sources are different. Medical insurance for urban workers is paid by employers and individual workers and does not enjoy government subsidies. The payment standard of urban residents' medical insurance is generally lower than that of employees' medical insurance, and the government gives appropriate subsidies on the basis of individual contributions;
Third, the treatment standards are different. Due to the low level of financing, the medical treatment standard of urban residents' medical insurance is slightly lower than that of employees' medical insurance.
Fourth, the payment requirements are different. If the minimum payment period is set for medical insurance for urban workers, if the payment period reaches 25 years for men and 20 years for women, they can enjoy basic medical insurance benefits without paying after retirement; There is no minimum payment period for urban residents' medical insurance, which must be paid every year. If you don't pay, you won't enjoy the treatment.
Medical insurance subsidy editor
20 13
Wen Jiabao, Premier of the State Council, presided over the the State Council executive meeting to study and deploy the work of deepening the reform of the medical and health system during the Twelfth Five-Year Plan period. The meeting pointed out that the current medical reform still faces some prominent contradictions and problems, especially the deep-seated contradictions such as institutional and structural problems have not been resolved. We must further strengthen organizational leadership and push the reform deeper.
The meeting said that during the "Twelfth Five-Year Plan" period, we should focus on building a basic medical and health system in line with China's national conditions and make key breakthroughs in three aspects:
First, speed up the improvement of the universal medical insurance system. Consolidate and expand the coverage of basic medical insurance, focusing on migrant workers, employees of non-public economic organizations, flexible employees, retirees of bankrupt enterprises and employees of difficult enterprises. Improve the level of basic medical security. By 20 15, the government subsidy standard for urban residents' medical insurance and the new rural cooperative medical system will be raised to above 360 yuan per person per year, and the proportion of hospitalization expenses within the scope of the three basic medical insurance policies will reach about 75%. Reform and improve the medical insurance payment and medical assistance system. Actively develop commercial health insurance.
The second is to consolidate and improve the basic drug system and the new mechanism for the operation of primary medical and health institutions. The implementation scope of the basic drug system has gradually expanded to village clinics and private primary medical and health institutions. Continue to support the standardization construction of village clinics, township hospitals and community health service institutions, and train more than 0.5 million general practitioners/kloc-0 for primary medical and health institutions.
Third, actively promote the reform of public hospitals. Deepen the reform of compensation mechanism, break the mechanism of "supporting doctors with medicine" and promote the separation of medicine and management. Establish modern hospital management system, standardize diagnosis and treatment behavior, and mobilize the enthusiasm of medical staff. In 20 15 years, it is necessary to realize the phased reform goal of county-level public hospitals and comprehensively push forward the reform of urban public hospitals.
20 14
On April 25th, 20 14, it was learned from Ministry of Human Resources and Social Security that China will further improve the financial subsidy standard for urban residents' medical insurance, and the per capita will not be lower than that of 320 yuan in 20 14, and the individual payment standard will be adjusted accordingly. [ 1]
20 15
Ministry of Human Resources and Social Security and the Ministry of Finance jointly issued the "Notice on Doing a Good Job in the Basic Medical Insurance for Urban Residents in 20 15", which pointed out that in 20 15, the subsidy standard for residents' medical insurance by governments at all levels increased the 60 yuan on the basis of 20 14, reaching the per capita 380 yuan. Among them, the central government subsidizes the base 120 yuan according to the original proportion, 260 yuan, which is increased according to the proportion of 80% in the western region and 60% in the central region, and the eastern provinces according to a certain proportion. At the same time, in order to balance the responsibilities of the government and individuals, a sustainable financing mechanism should be established. In 90 yuan, where the per capita contribution of residents in 20 15 years is not less than 20 14 years, 30 yuan will be increased to reach the per capita contribution of not less than 120 yuan. [2]
Implementation case editing
Starting from 20 15, the new standard will also be implemented for the individual contribution of basic medical insurance for urban residents in Beijing. This is the first time since 20 1 1 that Beijing has raised the individual payment standard of medical insurance for urban residents. [3]
Among them, the individual payment standard for students and children is adjusted from 100 yuan per person per year to 160 yuan per person per year; The elderly in cities and towns are adjusted from 300 yuan to 360 yuan per person per year. Unemployed residents are adjusted from 600 yuan to 660 yuan per person per year, and unemployed disabled residents and 7- 10 disabled soldiers are adjusted from 300 yuan to 360 yuan per person per year. [3]
In 20 15 years, the payment time for urban residents' medical insurance is from September 20 14 to the end of165438+10. Insured residents should go through the insurance formalities in time according to the new standards, and fully prepare the insurance payment funds. [3]
At present, the reimbursement policy for residents' medical insurance outpatient service requires continuous participation 1 year or more. If you don't go through the formalities of insurance payment on time, your payment may be cut off, which will affect the outpatient reimbursement of the insured person next year. [3]
Edit according to law
Guiding Opinions of the State Council on Piloting Basic Medical Insurance for Urban Residents
Guo Fa [2007] No.20
People's governments of all provinces, autonomous regions and municipalities directly under the Central Government, ministries and commissions and institutions directly under the State Council:
The CPC Central Committee and the State Council attached great importance to solving the medical security problems of the broad masses of the people and constantly improved the medical security system. From 65438 to 0998, China began to establish a basic medical insurance system for urban workers, and then launched a new rural cooperative medical system to establish a medical assistance system for urban and rural areas. At present, there is no medical security system arrangement mainly for urban non-employed residents. In order to achieve the goal of basically establishing a medical security system covering urban and rural residents, the State Council decided to start the pilot project of basic medical insurance for urban residents in 2007. All localities and departments should fully understand the importance of this work, regard it as an important task to implement Scientific Outlook on Development and build a harmonious socialist society, attach great importance to it, make overall plans, standardize and guide it, and make steady progress.
Goal principle
(1) pilot target. In 2007, there was an article.
Medical insurance for urban residents
In 2008, two or three cities were selected to start the pilot project, and the scope of the pilot project was expanded. The target was to reach more than 80% of the pilot cities in 2009, and it will be fully opened nationwide in 20 10, gradually covering all urban non-employed residents. It is necessary to explore and improve the basic medical insurance policy system for urban residents through pilot projects, form a reasonable financing mechanism, a sound management system and a standardized operating mechanism, and gradually establish a basic medical insurance system for urban residents with serious illnesses.
(2) Pilot principle. The pilot work should start at a low level, reasonably determine the financing level and security standards according to the level of economic development and the affordability of all aspects, focus on ensuring the medical needs of non-employed urban residents for serious illnesses, and gradually improve the level of security; Adhere to the principle of voluntariness and fully respect the wishes of the masses; Clarify the responsibilities of the central and local governments, the central government determines the basic principles and main policies, and the local governments formulate specific measures to implement territorial management of insured residents; Adhere to overall planning and coordination, and do a good job in connecting basic policies, standards and management measures among various medical security systems.
Insurance coverage and financing level
(3) Insurance coverage. Students, children and other non-employed urban residents in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools) not covered by the basic medical insurance system for urban workers may voluntarily participate in the basic medical insurance for urban residents.
(4) Financing level. According to the local economic development level and the basic medical consumption needs of different groups such as adults and minors, the pilot cities should comprehensively consider the affordability of local residents' families and finances and appropriately determine the financing level; Explore the establishment of a mechanism linking the level of financing, payment period and treatment level.
(5) Payment and subsidies. The basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies. Insured residents are required to pay the basic medical insurance premium and enjoy the corresponding medical insurance benefits. Conditional employers can subsidize employees' families to pay insurance premiums. The state formulates preferential tax policies for individual contributions and unit subsidy funds.
For the insured residents in the pilot cities, the government will give subsidies according to the standard of not less than 40 yuan per capita every year. Among them, since 2007, the central government has given subsidies to the central and western regions according to the standard of 20 yuan per capita. On this basis, the government shall, in principle, subsidize the part of family contributions required for students and children with minimal living allowance or severe disabilities to participate in the insurance, and the central government shall subsidize the central and western regions according to the per capita 5 yuan; For other low-income households, severely disabled people who have lost their ability to work, elderly people over the age of 60 from low-income families and other residents in need of insurance payment, the government gives subsidies every year according to the standard of not less than 60 yuan per capita. Among them, the central government gives subsidies to the central and western regions according to the per capita 30 yuan. The central government will give appropriate subsidies to the eastern region with reference to the subsidy measures for the new rural cooperative medical system. The specific scheme of financial subsidies is determined by the financial department, labor and social security, civil affairs and other departments, and the subsidy funds are included in the financial budgets of governments at all levels.
(6) Payment of expenses. The basic medical insurance fund for urban residents is mainly used for the hospitalization and outpatient medical expenses of insured residents, and areas with conditions can gradually try out the outpatient medical expenses as a whole.
The use of the basic medical insurance fund for urban residents should adhere to the principle of fixed income and expenditure, balance of payments and slight balance. It is necessary to reasonably formulate the minimum payment standard, payment ratio and maximum payment limit of the basic medical insurance fund for urban residents, improve the payment method, and reasonably control the medical expenses. Explore medical services and payment methods suitable for the economic affordability of non-employed residents in difficult towns, and reduce the burden of medical expenses. The basic medical insurance fund for urban residents is used to pay medical expenses within the prescribed scope, and other expenses can be solved by supplementary medical insurance, commercial health insurance, medical assistance and social charitable donations. [4]
(7) organization and management. The management of the basic medical insurance for urban residents shall, in principle, refer to the relevant provisions of the basic medical insurance for urban workers. All localities should make full use of the existing management service system, improve management methods and improve management efficiency. Encourage qualified areas to combine the basic medical insurance for urban workers and the actual management of new rural cooperative medical care, and further integrate the management resources of basic medical security. It is necessary to explore the establishment and improvement of social supervision organizations for medical insurance composed of representatives of government agencies, insured residents, social organizations and medical service institutions, and strengthen supervision over the management, service and operation of basic medical insurance for urban residents. Establish medical insurance professional technical standards organizations and expert consultation organizations, and improve medical insurance service management professional technical standards and business norms. According to the needs of the development of medical insurance, strengthen the construction of medical insurance management service institutions and teams. Establish and improve the management system, improve the operation mechanism, and strengthen the construction of medical insurance information system.
(8) Fund management. The basic medical insurance fund for urban residents should be included in the unified management of the financial accounts of social security funds and accounted for separately. Pilot cities should strictly implement the financial system, strengthen the management and supervision of basic medical insurance funds, and explore the establishment and improvement of fund risk prevention and adjustment mechanisms in accordance with the relevant provisions of social insurance fund management to ensure the safety of funds.
(9) Service management. The medical service management of the basic medical insurance for urban residents shall refer to the relevant provisions of the basic medical insurance for urban workers in principle, and the specific measures shall be formulated by the labor and social security department of the pilot city in conjunction with the departments of development and reform, finance and health. It is necessary to comprehensively consider the basic medical needs of the insured residents and the affordability of the basic medical insurance fund, and reasonably determine the scope of medical services. Through the conclusion and performance of the designated service agreement, the management of designated medical institutions and designated retail pharmacies will be standardized, and the rights and obligations of medical insurance agencies and designated medical institutions and retail pharmacies will be clarified. Medical insurance agencies should simplify examination and approval procedures to facilitate residents' participation in insurance and reimbursement of medical expenses; Clarify the settlement method of medical expenses and settle with medical institutions in a timely manner according to regulations. Strengthen the management of medical expenses and explore the establishment of a reward and punishment mechanism for medical insurance management services. Actively promote the payment of medical expenses according to diseases and the total amount in advance, and explore ways to determine the standard of medical expenses by agreement.
(ten) give full play to the role of urban community service organizations. Integrate, upgrade and broaden the functions of urban community service institutions, strengthen the construction of community service platforms, and do a good job in the management and service of basic medical insurance. Vigorously develop community health services and bring qualified community health service institutions into the designated scope of medical insurance; The proportion of medical expenses incurred by insured residents in community health service institutions should be appropriately increased.
(eleven) continue to improve the medical security system. Further improve the basic medical insurance system for urban workers and take effective measures to bring mixed ownership, non-public economic organizations and flexible employees into the basic medical insurance for urban workers; Vigorously promote migrant workers to participate in the basic medical insurance for urban workers, focusing on solving the problem of serious illness; Continue to focus on solving the medical security problems of employees and retirees such as state-owned enterprises with difficulties and closed bankrupt enterprises; Encourage urban residents of working age who have the ability to work to find jobs in various ways and participate in the basic medical insurance for urban workers; Further standardize the current payment policy of basic medical insurance for urban workers and strengthen the management of medical services. Accelerate the implementation of the new rural cooperative medical system. Further improve the urban and rural medical assistance system. Improve the multi-level medical security system and do a good job in the connection of various medical security systems.
(twelve) to promote the reform of the medical and health system and the drug production and circulation system. In accordance with the overall requirements of deepening the reform of the medical and health system, we should coordinate the reform and system convergence of medical and health care, drug production and circulation and medical security system, and give full play to the role of medical security system in raising medical funds, improving medical quality and controlling medical expenses. Further transform government functions, strengthen regional health planning and improve the medical service system. Establish and improve the health industry standard system, and strengthen the supervision of medical services and drug markets. Standardize medical service behavior, and gradually establish and improve technical standards such as clinical operation norms, clinical diagnosis and treatment guidelines, clinical medication norms, and admission standards. Accelerate the construction of urban community health service system, give full play to the role of community health service and Chinese medicine service in medical services, and explore the implementation of graded medical care for insured residents in areas where conditions permit.
(thirteen) the establishment of the State Council urban residents basic medical insurance inter ministerial joint conference system. Under the leadership of the State Council, the Inter-Ministerial Joint Conference on Basic Medical Insurance for Urban Residents in the State Council is responsible for organizing, coordinating and guiding the pilot work, studying and formulating relevant policies, supervising and inspecting the implementation of policies, summarizing and evaluating the pilot work, coordinating and solving the problems in the pilot work, and submitting reports and suggestions to the State Council on major issues.
(fourteen) choose to determine the pilot city. The provincial people's government may choose 2 to 3 pilot cities according to local conditions and report them to the inter-ministerial joint meeting for approval. The implementation plan of pilot cities shall be reported to the office of the inter-ministerial joint meeting for the record and approved by the people's governments of all provinces (autonomous regions and municipalities).
(fifteen) to formulate supporting policies and measures. The labor and social security department shall formulate relevant supporting policies and measures in conjunction with relevant departments such as development and reform, finance, health, civil affairs, education, drug supervision, and Chinese medicine management. All departments should cooperate with each other according to their respective responsibilities and accelerate various supporting reforms. Mobilize all social forces to create a good environment and provide strong support for promoting the reform of the medical insurance system, and ensure the smooth progress of the pilot work.
(sixteen) carefully organized and implemented. Local people's governments at all levels should fully understand the great significance of the pilot work and earnestly strengthen organizational leadership. The people's governments at the provincial level shall make overall plans according to the pilot objectives, tasks, basic policies and work steps stipulated in this guidance, and actively and steadily promote the pilot work in their respective administrative areas. Pilot cities should formulate pilot implementation plans and carefully organize their implementation on the basis of full investigation, careful calculation and multi-party demonstration. Cities that have carried out basic medical insurance should sum up experience in time, improve their systems, and further explore more practical basic medical insurance systems and mechanisms.
(seventeen) do a good job in public opinion propaganda. The establishment of the basic medical insurance system for urban residents is directly related to the vital interests of the broad masses of the people and is a major livelihood project with strong policy. All localities should adhere to the correct guidance of public opinion, strengthen the publicity of the significance, basic principles, principles and policies of the pilot work, and strengthen the summary and popularization of good practices and experiences in the pilot work, so that this policy of benefiting the people will be deeply rooted in the hearts of the people and truly gain the understanding and support of the broad masses and all sectors of society, so that the pilot work will become a practice in which the broad masses actively participate.
All localities should pay attention to the study of new situations and problems in the pilot process, actively explore solutions, and properly handle the relationship between reform, development and stability. In case of important circumstances, report to the inter-ministerial joint meeting in time.
The State Council July 2007 10 [4]
reference data
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.