Supplementary Notice on Policy Adjustments
Municipal Medical Insurance Fund Management Center, County and Municipal Personnel, Labor and Social Security Bureaus:
Since the implementation of the "Interim Measures for the Basic Medical Insurance for Urban Residents of Xianyang City" in October last year, with the great attention of the municipal party committee and the municipal government, and through the hard work of the labor and security departments at the city and county levels, the pilot project of the basic medical insurance for urban residents has been carried out. Good social effects have been achieved. In order to further improve our city's basic medical insurance policy for urban residents and improve the treatment level of insured residents, combined with the actual situation of our city's basic medical insurance for urban residents, the following adjustments and supplements are made to the "Implementation Rules of Xianyang Basic Medical Insurance for Urban Residents":
1. The city’s basic medical insurance for urban residents shall be coordinated at the municipal level.
2. Basic medical insurance premiums for urban residents are collected and paid in a natural year, and the payment period for the next year is from September 1st to December 31st each year.
1. Urban residents newly insured in 2009 are subject to a three-month waiting period for medical benefits; urban residents insured after 2009 are subject to a six-month waiting period for medical benefits, and are not allowed to enjoy basic medical care during the waiting period. Insurance benefits.
2. If insured residents fail to pay the new year’s medical insurance premium on time, they will enjoy basic medical insurance benefits from the month after payment.
3. If the payment of premiums is interrupted for more than one year (including one year) after joining the insurance, there will be a 3-month waiting period for medical insurance benefits starting from the month after the renewal is processed.
3. Lower the minimum payment standard (see the table below for details):
Hospital level by age group
Minimum payment standard (yuan)
18 weeks
Over 600 for third-level hospitals
320 for second-level hospitals
180 for first-level hospitals
Community health care Service Center
120
18 weeks
Three-level hospitals under the age of 300
Second-level hospitals 200
First-level hospitals 100
Community medical and health service centers
60
4. Increase the payment ratio of the basic medical insurance pooling fund.
50% are designated third-level hospitals; 65% are second-level hospitals; 70% are first-level hospitals; and 80% are community medical and health service centers.
5. Expand the payment scope of the basic medical insurance pooling fund.
1. Among the insured residents, the childbirth of women in compliance with national policies shall be included in the payment scope of the basic medical insurance co-ordinating fund.
2. Accidental injuries to students and children who are not third-party responsible persons are included in the payment scope of the basic medical insurance co-ordination fund.
6. Increase the proportion of medical insurance funds paying for disposable blood pipelines used by hemodialysis patients.
When the cost of one-time blood pipeline used by hemodialysis patients is ≤30 yuan, 10% will be borne by designated medical institutions, 30% will be borne by insured residents, and 60% will be borne by the basic medical insurance co-ordinating fund. Any amount exceeding RMB 30 will be fully borne by designated medical institutions.
7. Increase the number of diseases for single-disease settlement and increase the fund payment ratio.
1. The number of diseases settled under a single category has increased to eleven. The new categories include: thoracic and lumbar fractures (except first-degree compression fractures and simple accessory fractures), humeral shaft fractures, and pelvic fractures. (Classified by Tile, except stable type), femoral shaft fracture.
2. The disease burden ratio for single-disease settlement is adjusted to: Level 3 designated hospitals bear 13%, Level 2 designated hospitals bear 11%, and Level 1 designated hospitals bear 9%; the medical insurance fund pays Level 3 42% are designated hospitals, 52% are second-level designated hospitals, and 62% are first-level designated hospitals.
8. Increase the types of diseases that are paid according to the type of disease and increase the limit of medical expenses.
1. Newly paid diseases based on disease type: coronary artery bypass grafting, cardiac radiofrequency ablation, and artificial knee replacement.