Article 1 In order to ensure the basic medical care for urban residents, further improve the medical insurance system and build a harmonious society, according to the Guiding Opinions on Launching the Pilot Project of Basic Medical Insurance for Urban Residents of the State Council (Guo Fa [27] No.2), the Implementation Opinions on Establishing the Basic Medical Insurance System for Urban Residents of Hebei Province (Ji Zheng [27] No.99) and the Basic Medical Insurance for Urban Residents of Hengshui City,

article 2 the basic medical insurance system for urban residents adheres to the principle of low level and wide coverage, and makes corresponding institutional arrangements for medical security for different levels of groups, and reasonably determines the financing standard and security level according to the level of economic development and the affordability of all aspects, focusing on ensuring the medical needs of residents with serious illnesses in hospitals and outpatient clinics; Adhere to the principle of family as a unit, voluntary participation of the masses, and the combination of individual contributions and government subsidies; Adhere to the principle of overall coordination and unified management, and do a good job in connecting the basic policies, standards and management measures between various medical security systems.

article 3 the basic medical insurance for urban residents takes the county as the overall unit, and the county government is responsible for unified coordination and management. The county government set up a leading group for urban residents' basic medical insurance, which is responsible for organizing, coordinating and providing macro guidance, studying and formulating relevant policies, supervising and inspecting the implementation of policies, and coordinating and solving problems arising in the work. All relevant departments cooperate closely to do a good job in the basic medical insurance for urban residents.

Article 4 County Personnel, Labor and Social Security Bureau is the administrative department in charge of residents' medical insurance, and is responsible for the formulation, implementation, management and supervision of the basic medical insurance policy for urban residents; The county finance bureau is responsible for the budget arrangement and appropriation of financial subsidy funds, strengthening the supervision and management of funds, implementing matching funds, and ensuring the funds needed for the basic medical insurance for urban residents and including them in the fiscal budget; County Health Bureau is responsible for the supervision of medical institutions, improve the construction of community health service institutions, and provide basic medical services with high quality and low price for insured residents; County Education Bureau is responsible for the publicity and mobilization of primary and secondary school students and kindergarten children's insurance work, to implement the target responsibility system, the responsibility to schools, kindergartens, so that all insurance should be guaranteed; The county public security bureau is responsible for the household registration identification of the insured, providing relevant basic data and timely providing information on the settlement of newborns; County Civil Affairs Bureau is responsible for the identification of low-income residents and elderly people over 6 years old in low-income families, and cooperate with labor and social security departments to do a good job in data statistics and insurance registration of poor people; County Disabled Persons' Federation is responsible for severe disability (1? Level 2) personnel identification, cooperate with the labor and social security department to do a good job in the registration of disabled people; The township governments shall be responsible for the publicity, mobilization and insurance of urban residents within their respective township areas; County Development and Reform Bureau, Food and Drug Administration and other departments are responsible for formulating relevant supporting policies and measures to assist in the basic medical insurance for urban residents. The above departments should do a good job in starting the basic medical insurance for urban residents in accordance with their respective responsibilities.

the county medical insurance center is specifically responsible for handling the basic medical insurance for urban residents in the county, and undertaking the insurance participation of urban residents (except schools and kindergartens) in the county. Township labor and social security service stations and schools are the agencies for the basic medical insurance for urban residents. Under the guidance of the labor and social security departments, they specifically undertake the publicity and mobilization of residents' insurance, insurance registration, qualification examination, basic information entry, change, summary report and medical insurance, and the collection and distribution of IC cards.

Chapter II Scope of Insurance

Article 5 All non-employed urban residents who have not participated in the basic medical insurance for urban workers within their respective administrative areas may voluntarily participate in the basic medical insurance for urban residents. Including:

(1) primary and secondary school students (including vocational education centers, senior high schools, junior high schools, primary school students and kindergarten children)

(2) non-school residents under the age of 18;

(3) Unemployed urban residents over the age of 18.

article 6 other persons who meet the relevant national and provincial policies and regulations and the spirit of the document may voluntarily participate in the basic medical insurance for urban residents. Including:

(1) flexible employees and migrant workers;

(2) closing retirees of bankrupt enterprises (including retirees who have not participated in the basic medical insurance for urban workers) and closing employees of bankrupt enterprises.

Chapter III Financing Standards and Subsidies

Article 7 The insured shall be supplemented by the county finance in addition to the central and provincial financial subsidies.

article 8

(1) for all kinds of students and non-school residents under the age of 18, the funding standard for medical insurance premium is 16 yuan per person per year (including 1 yuan with large medical insurance premium), and individuals pay 3 yuan, and the rest is supplemented by the central, provincial and county finances.

(2) The funding standard for medical insurance premium for urban residents over 18 years old is 3 yuan per person per year (including 5 yuan with large medical insurance premium). Individuals pay 17 yuan, and the rest is supplemented by the central, provincial and county finances. (In 29, the standard of medical insurance fee for residents over the age of 18 in the second half of the year was 85 yuan paid by individuals, including 25 yuan with large medical insurance fee).

the medical insurance premiums of the above-mentioned people, such as the minimum living allowances, severely disabled (grade 1-2) residents and the elderly over 6 years old in low-income families, are all borne by the financial subsidy funds, and the rest are subsidized by the county finance except the central and provincial financial subsidies.

article 9 an employer with conditions may grant subsidies to employees' family members for insurance payment, and the unit subsidy funds shall be paid before tax.

Chapter IV Registration of Insurance and Collection of Funds

Article 1 All kinds of students and kindergarten children shall be appointed by their schools and kindergartens as medical insurance administrators, and the insurance procedures shall be organized in a unified manner. Students and kindergarten children should provide their ID numbers when registering for insurance, and I have two recent bareheaded photos of my second child. Schools and kindergartens should promptly submit the basic information of the insured and the medical insurance premiums collected to the county medical insurance center or the designated bank account.

urban residents hold one original and one copy of their household registration book and ID card, and two recent bareheaded color photos of themselves (photos are not required for children before going to kindergarten), and go to the county medical insurance center and the township labor security service station to go through the insurance payment procedures. After the county medical insurance center and the township labor and social security service station have passed the examination of the residents' application materials, they will print the payment documents for the insured residents and go through the relevant registration procedures, and the insured residents will pay the medical insurance premium to the bank account designated by the medical insurance center.

The following personnel should hold valid proof materials such as low assurance and severe disability certificate (1 original and 1 copy) issued by the civil affairs department or the Disabled Persons' Federation, and go to the county medical insurance center to go through the insurance formalities directly after posting the public notice without objection by the insurance registration department:

(1) the minimum living allowance object;

(2) urban residents with severe disabilities (including all kinds of students);

(3) elderly people over 6 years old in families whose annual per capita income is less than one third of the annual per capita disposable income of residents in this county (proof of identification of low-income families issued by the Civil Affairs Bureau shall be provided).

article 11 the insured residents take the family as the unit, and those who meet the conditions of basic medical insurance for urban residents must be insured at the same time (except those who have participated in the basic medical insurance for urban workers and the new rural cooperative medical system), and all kinds of students take the school as the insured unit and go through the insurance procedures collectively.

Article 12 Newborns shall go through the insurance formalities within 3 months from the date of household registration.

Article 13 The medical insurance for urban residents shall be paid in advance for one year, with one year as the payment period for medical treatment.

(1) all kinds of students and kindergarten children pay fees according to the school year, register and change the relevant insurance information at the beginning of each school year, and pay the basic medical insurance premium for this school year. The payment period of medical insurance benefits is from October 1 of that year to September 3 of the following year.

(2) Non-school residents under the age of 18 and urban residents over the age of 18 are paid annually. From September 1st to October 31st every year, the registration, advance payment and change of residents' medical insurance information will be handled centrally. In 29, the medical insurance fee will be collected for half a year and the medical expenses in the second half of the year will be reimbursed. In January 21, the medical insurance fee will be collected from September to October every year, and the payment period of medical insurance benefits will be from January 1 to December 31 of the following year.

Article 14 The county medical insurance center shall report the number of insured residents and the amount of financial subsidies to the financial department before November 3th each year, which will include them in the next year's budget. The financial department will allocate the financial subsidy funds to the financial accounts of the county medical insurance center before the end of January of the following year.

Article 15 The basic medical insurance for urban residents shall only be established as a unified fund, and no individual account shall be established.

sixteenth urban residents' basic medical insurance contributions will not be refunded after they are included in the overall fund.

chapter v treatment of medical insurance

article 17 the basic medical insurance for urban residents shall implement the relevant provisions of the basic medical insurance for urban workers in Hebei province, such as the list of drugs, the list of medical treatment items, medical service facilities and standards, and on this basis, appropriately increase the variety and scope of drugs used by children. The expenses incurred in hospitalization are directly settled with the designated medical institutions except for the part borne by the individual, and the rest is settled with the designated medical institutions by the county medical insurance center.

Article 18 The payment scope of the overall fund includes:

(1) paying the hospitalization expenses of non-student urban residents who meet the requirements of the basic medical insurance for urban residents and the outpatient expenses incurred by radiotherapy and chemotherapy for malignant tumors, dialysis for uremia clinics and taking anti-rejection drugs after liver and kidney transplantation;

(2) Pay the hospitalization expenses for diseases and accidental injuries of all kinds of students, non-school residents under the age of 18, outpatient expenses for chemotherapy and radiotherapy for malignant tumors, outpatient dialysis for uremia, outpatient expenses for taking anti-rejection drugs after liver and kidney transplantation, aplastic anemia and hematological diseases in remission stage of leukemia.

Article 19 Urban insured residents need to pay a certain amount of medical expenses for each hospitalization, that is, Qifubiaozhun. Qifubiaozhun is determined according to different levels of medical institutions: the first-level designated medical institutions are 3 yuan (including designated community health service centers), the second-level designated medical institutions are 5 yuan, and the third-level designated medical institutions are 7 yuan.

the proportion of hospitalization reimbursement for insured residents is: 7% of designated medical institutions (including designated community health service centers) with Qifubiaozhun above the first level, 6% of designated medical institutions at the second level and 5% of designated medical institutions at the third level.

the maximum annual payment limit of the overall fund is 3, yuan per person.

Article 2 If it belongs to the diagnosis and treatment items for which part of the expenses are paid by the basic medical insurance for urban residents, and the drugs listed in the drug list of the basic medical insurance for urban residents are used, the individual shall pay 1% first, and the remaining 9% shall be paid by the individual and the overall fund according to the prescribed proportion.

Article 21 Insured residents suffering from malignant tumor outpatient radiotherapy and chemotherapy, uremia outpatient dialysis and taking anti-rejection drugs after liver and kidney transplantation (all kinds of students and non-school residents under the age of 18, including aplastic anemia and hematological diseases in remission stage of leukemia) need outpatient treatment, and hold their own medical insurance (IC card), recent diagnosis certificate of designated medical institutions at or above the second level, copies of hospitalization medical records and relevant inspection and laboratory reports and other materials. After being reported to the labor and social security department for confirmation, they will receive the Outpatient Medical Certificate for Special Diseases of Basic Medical Insurance for Urban Residents, and go to the designated medical institutions for medical treatment with certificates. The outpatient treatment can be included in the payment scope of the basic medical insurance fund for urban residents, with the annual Qifubiaozhun of 5 yuan, and the medical expenses above the Qifubiaozhun and below the maximum payment limit, according to the relevant provisions of hospitalization in the second-level designated medical institutions in the county.

Article 22 The payment period is linked to the medical insurance benefits. The proportion of urban residents' basic medical insurance fund payment will increase by 3% every 5 years, and the cumulative maximum will not exceed 9%. If the insured residents interrupt the payment, they will be re-insured to recalculate the payment period according to the new insured.

article 23 referring to the operation mode of large-scale medical insurance for urban workers, the large-scale medical insurance for urban residents shall be co-ordinated at the municipal level, and the municipal medical insurance agency shall uniformly apply to commercial insurance companies. If the hospitalization and outpatient expenses of the insured exceed the maximum payment limit of the urban residents' basic medical insurance co-ordination fund, 75% of the medical expenses in Class A that meet the requirements of basic medical insurance shall be paid by large medical insurance, 25% by individuals, and 1% by Class B first, and then paid according to this proportion. The maximum payment limit of large medical insurance in a settlement year is 7 yuan.

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