chapter I

general provisions

article 2 the basic medical insurance for urban residents as mentioned in these measures refers to a system sponsored by the government, which combines the household registration payment of the family permanent population with appropriate subsidies from the government, and the insured residents pay the basic medical insurance premium according to regulations and enjoy the corresponding medical insurance benefits.

article 3 the basic medical insurance for urban residents adheres to the principle of voluntariness, implements territorial management according to the place where the household registration is located (students are subject to their school status), and encourages enterprises to give appropriate subsidies to the individual contributions of employees' families. For the time being, counties (cities) and districts will be the overall planning units, and municipal overall planning will be implemented when conditions are ripe.

article 4 the basic medical insurance for urban residents shall adhere to the principle of starting at a low level and adapting the level of financing, payment period and payment level, focusing on ensuring hospitalization and serious illness.

Article 5 The labor and social security departments of counties (cities) and districts are the departments in charge of basic medical insurance for urban residents in counties (cities) and districts, and their medical insurance agencies specifically undertake the basic medical insurance business for urban residents and are responsible for organizing the implementation of these Measures.

the labor security offices of subdistrict offices and township governments shall, in accordance with the provisions of these measures, be responsible for the declaration and registration, material review, information entry and other work of the basic medical insurance for urban residents within their respective jurisdictions, and organize residents to pay the medical insurance premiums in families and pay them at the social security window of the local tax department.

the financial department is responsible for formulating the financial subsidy policy for the basic medical insurance for urban residents in conjunction with relevant departments, and doing a good job in budget arrangement, fund allocation and fund supervision.

the local tax department is responsible for the unified collection and payment of basic medical insurance premiums for urban residents.

the health department is responsible for the planning, construction and network layout of health service institutions, and supervises and manages the quality of medical services.

the education department is responsible for coordinating the school to do a good job in enrollment registration and the collection and payment of medical insurance premiums. Taking the school as a unit, it will go to the local medical insurance agency to handle enrollment registration and payment procedures for students in school.

the civil affairs department is responsible for identifying the urban residents who enjoy the minimum living guarantee in this city, organizing and guiding the low-income workers to participate in the insurance, and supporting the medical assistance work.

The Disabled Persons' Federation is responsible for the identification and enrollment of severely disabled persons.

Personnel, development and reform, public security, price, food and drug supervision, auditing, banking and other departments should do a good job in the basic medical insurance for urban residents according to their respective duties.

chapter ii

coverage and funding standards

article 6 coverage

(1) students in full-time colleges and technical secondary schools, technical schools, vocational high schools, ordinary high schools, junior high schools and primary schools within the scope of this municipality.

(2) Preschool children with urban household registration in this city and non-school urban residents under the age of 18.

(3) people with minimum living allowances, severely disabled people and elderly people over 6 years old with urban household registration in this city.

(4) Urban residents who have urban household registration in this city and are not covered by the basic medical insurance for urban workers.

(5) after the implementation of these measures, people whose household registration has moved into this city from other places and who meet the conditions for participating in the basic medical insurance for urban residents may participate in the basic medical insurance for urban residents in this city in accordance with the provisions of these measures.

(6) those who participate in the basic medical insurance for urban workers are not allowed to participate in the basic medical insurance for urban residents at the same time. One-time resettlement personnel and mixed-post personnel can choose according to their own conditions. Other social workers participate in the basic medical insurance for urban workers or residents according to the employment situation.

Article 7 The basic medical fund for urban residents shall be raised on a family basis, and the raising criteria are as follows:

(1) Each urban resident shall raise funds according to the standards of 17 yuan every year. The government subsidizes 8 yuan and individuals pay 9 yuan. 17 yuan, a low-income person, a severely disabled person who has lost the ability to work, and an elderly person over 6 years old in a low-income family, receives a government subsidy of 136 yuan, and individuals pay 34 yuan.

(2) All kinds of students in primary and secondary schools and non-school personnel under the age of 18 are raised annually according to the 11 yuan. The government subsidizes 8 yuan and individuals pay 3 yuan. Students and children who belong to low-income families or have severe disabilities are subsidized by the government in 95 yuan, and individuals pay 15 yuan.

local government subsidy funds: each district (bureau) shall bear 5 yuan/person year by the municipal finance and 15 yuan/person year by the district (bureau) finance; Tieli city and Jiayin counties and cities will no longer provide financial subsidies, and each will bear the 2 yuan/person year.

article 8 the basic medical insurance premium for urban residents shall be paid on an annual basis, and all members in the household registration book shall be regarded as an insured unit, and a natural year shall be regarded as an insurance year to declare and pay the premium on an annual basis. Students in the school take the school as the insured unit, declare and pay fees according to the academic year (from September 1st of that year to August 31st of the following year), and settle accounts according to the academic year.

in 29, February 28th is the deadline for payment, and the next month of payment will enjoy corresponding treatment. From October 1 to December 31 every year, you will pay the fees and enjoy the basic medical insurance benefits from January 1 of the following year. If the payment is not made on time within the payment period, it will be regarded as intermittent payment. If the payment is intermittent, the unpaid part will be paid back and a waiting period of 6 months will be set. Expenses incurred during the waiting period of treatment will not be written off.

article 9 urban residents who meet the conditions for participating in insurance shall go through the procedures of participating in insurance and paying fees at the street labor security office, community labor security workstation or local medical insurance agency with their household registration book, identity card and proof that they have not participated in the basic medical insurance for urban workers, and pay the medical insurance fee at the social security window of the local tax department, and the medical insurance agency will issue the basic medical insurance certificate or medical insurance card.

article 1 the basic medical insurance premium paid by urban residents is only used to establish a pool fund, and no personal account is established. If the insured person goes abroad to settle down, join the army, move out of the household registration or die, the medical insurance relationship will automatically terminate and withdraw from the basic medical insurance for urban residents, and the basic medical insurance premium paid by him will not be refunded.

chapter iii

medical insurance benefits

article 11 the overall fund for urban residents' basic medical insurance shall be implemented in accordance with the "three catalogues", namely, the catalogue of drugs for basic medical insurance and work-related injury insurance in Heilongjiang province, the opinions on the management of diagnosis and treatment projects for urban employees in Heilongjiang province, and the opinions on the scope of service facilities and payment standards for basic medical insurance for urban employees in Heilongjiang province. The insured urban residents who go to the designated hospitals for medical treatment meet the requirements of medical insurance, and the part above the deductible standard and below the maximum payment limit shall be paid by the medical insurance pooling fund in proportion.

article 12 in a medical insurance year, the maximum payment limit of basic medical insurance for urban residents is 1, yuan. For urban residents who have been insured for 5 years, the maximum payment limit will be raised to 15, yuan. During the trial period of these measures, the maximum payment limit will be increased by 5, yuan/person-year for every 5 years of continuous payment. The maximum payment limit for students and children is 2 thousand yuan.

(1) Qifubiaozhun for hospitalization: 4 yuan for each time in tertiary hospitals; The secondary hospital is 3 yuan every time; Level-1 hospital for each 2 yuan. Qifubiaozhun for multiple hospitalizations in a natural year is reduced from 1 yuan to 1 yuan.

(2) write-off standard for hospitalization: 55% for tertiary hospitals; Secondary hospitals write off 6%; First-class hospitals write off 65%. 5% of special examinations and special treatments were written off during hospitalization; The medical expenses incurred in transferring to a higher-level hospital outside the city will be reduced by 1% on the basis of the third-level hospital in this city; The medical expenses of insured persons living in different places are reduced by 1% on the basis of tertiary hospitals in this city.

(3) Verification standard for outpatient serious illness: 55% of insured residents with uremia will be verified as having hemodialysis; If the insured residents take anti-rejection drugs after kidney (liver) transplantation, 55% will be written off, and 55% will be written off after radiotherapy and chemotherapy for various cancers. Other outpatient serious illnesses are temporarily not within the scope of verification.

Chapter IV

Management of Medical Insurance

Article 13 The organization and management of the basic medical insurance for urban residents and the management of medical services shall be implemented with reference to the relevant provisions of the basic medical insurance for urban employees, and the specific implementation rules shall be formulated separately by the labor and social security department.

article 14 the basic medical insurance fund for urban residents adheres to the principle of fixed income and expenditure, balanced income and expenditure, and a slight balance, and implements two lines of financial accounts, separate accounts, earmarking and revenue and expenditure. The basic medical insurance for urban workers and the basic medical insurance fund for urban residents must be managed separately and operated separately.

Article 15 cannot be included in the settlement scope of urban residents' basic medical insurance expenses under the following circumstances.

(1) medical expenses incurred in going abroad on business or going to Hongkong, Macau and Taiwan Province.

(2) medical expenses incurred in work-related injuries and childbirth.

(3) medical expenses caused by traffic accidents, illegal crimes, fighting, alcoholism, self-mutilation, suicide, drug abuse, etc.

(4) Others should not be included in the payment scope of the basic medical insurance for urban residents.

Article 16 The basic medical insurance fund for urban residents shall be subject to supervision and audit by the financial and auditing departments. Medical insurance agencies regularly publish the use of the basic medical insurance fund for urban residents and relevant policy information, and report the income and expenditure to the administrative department of labor security every year, so as to adjust relevant policies in time.

Article 17 Medical institutions or individuals who defraud medical insurance funds shall be dealt with by relevant departments in accordance with relevant state regulations, and the defrauded funds shall be recovered; The staff of medical insurance institutions who cause the loss of medical insurance funds shall be investigated for administrative responsibility according to law.

article 18 the microcomputer software needed to start the medical insurance for urban residents shall be ordered by the municipal medical insurance bureau in a unified way, and all co-ordinating units shall share the cost; The required hardware shall be solved by each co-ordinating unit.

Article 19 All overall planning areas should be equipped with sufficient staff according to local conditions.

Chapter V

Supplementary Provisions

Article 2 The adjustment of the financing standard, government subsidy standard, minimum payment standard of the overall fund, maximum payment limit and payment ratio of the basic medical insurance for urban residents shall be put forward by the municipal labor and social security administrative department in conjunction with the financial departments according to the financing level and operation of the medical insurance fund in the previous year, and implemented after being approved by the municipal government.

article 21 these measures shall come into force as of 29. Yichun Municipal Labor and Social Security Bureau is responsible for the interpretation.