Measures of Zibo Municipality on Basic Medical Insurance for Urban Residents (for Trial Implementation) Chapter I General Provisions
Article 1 In order to establish and improve the medical security system and ensure the basic medical needs of urban residents, these Measures are formulated in accordance with the relevant provisions of the state and the actual situation of this Municipality.
Article 2 These Measures shall apply to the following non-employed urban residents who are not included in the basic medical insurance system for urban workers within the administrative area of this Municipality:
(1) Primary and secondary school students (including students from vocational high schools, technical secondary schools and technical schools) and children registered in kindergartens (hereinafter referred to as "primary and secondary school students");
(2) Children under the age of 18 who are not enrolled in the park or school (hereinafter referred to as "children");
(3) Urban residents of this Municipality, men aged 60 or above, women aged 55 or above and registered in this Municipality for two years (hereinafter referred to as "urban elderly residents");
(four) other non employed urban residents who are not included in the basic medical insurance system for urban workers (hereinafter referred to as "ordinary urban residents").
Article 3 The basic medical insurance system for urban residents adheres to the principles of low rate, wide coverage and serious illness protection; The basic medical insurance system for urban residents, the basic medical insurance system for urban workers, the new rural cooperative medical system and the social medical assistance system adhere to the principle of overall planning and coordinated development.
Article 4 The basic medical insurance fund for urban residents shall be subject to municipal overall planning, hierarchical management, planned control and quota adjustment.
Article 5 The municipal, district and county labor and social security administrative departments shall be responsible for the basic medical insurance for urban residents within their respective administrative areas, and their social insurance agencies shall undertake the basic medical insurance for urban residents in accordance with these Measures.
Sub-district offices and township governments shall, in accordance with the provisions of these Measures, be responsible for the declaration and registration, material review and information entry of the basic medical insurance for urban residents.
The financial department is responsible for the management and supervision of the basic medical insurance fund for urban residents; The health department is responsible for the construction and management of community medical institutions; The education department is responsible for organizing and coordinating urban primary and secondary school students to participate in the basic medical insurance for urban residents; The civil affairs department is responsible for the identification of urban residents who enjoy the minimum living guarantee in this city, organizing and guiding the minimum living guarantee personnel to participate in the insurance and supporting the medical assistance work; The Federation of Disabled Persons is responsible for the identification and insurance of severely disabled persons.
Public security, price, auditing, food and drug supervision and other departments should do a good job in the basic medical insurance for urban residents according to their respective responsibilities.
Article 6 The funds needed for the basic medical insurance for urban residents shall be borne by the finance at the same level.
Chapter II Fund Raising
Seventh basic medical insurance for urban residents is mainly based on family contributions, and the government gives appropriate subsidies.
Article 8 The basic medical insurance premium for urban residents shall be raised according to the following standards:
(a) primary and secondary school students and children are raised according to the standard of 80 yuan per person per year. Among them, individuals pay 40 yuan and the government subsidizes 40 yuan.
(two) the elderly urban residents are raised according to the standard of 220 yuan per person per year. Among them, individual contribution 120 yuan and government subsidy 100 yuan.
(three) the general urban residents are raised according to the standard of 220 yuan per person per year. Among them, individuals pay 160 yuan, and the government subsidizes 60 yuan.
Ninth insured residents in the minimum target and severely disabled, the basic medical insurance premium is raised according to the following standards:
(a) primary and secondary school students, children and individuals pay 20 yuan, and the government subsidizes 60 yuan.
(two) the elderly urban residents and ordinary urban residents to pay 40 yuan, government subsidies 180 yuan.
Tenth secondary and technical school students' government subsidies are fully subsidized by the municipal finance; Other primary and secondary school students, children, elderly urban residents and ordinary urban residents' government subsidy funds shall be shared by the municipal, district and county governments in the following proportion. Specifically: Zhangdian District, Zichuan District, Boshan District and zhoucun district City each bear 50% of the financial burden, and the district financial burden is 50%; Linzi District, Huantai County and High-tech Zone shall bear 40% of the municipal financial burden and 60% of the district and county financial burden; Gaoqing county, Yiyuan county by the municipal financial burden of 60%, the county financial burden of 40%.
Government subsidy funds are included in the fiscal budget on an annual basis.
Eleventh to encourage qualified employers to give subsidies to urban residents in their families. The balance of funds in the personal account of the basic medical insurance for urban workers can be used to pay the basic medical insurance premium for family members.
Twelfth basic medical insurance premiums for urban residents shall be collected by the following units:
(a) primary and secondary school students by the education department is responsible for the collection and distribution.
(2) Children, elderly urban residents and ordinary urban residents shall be collected and remitted by the neighborhood offices (township governments) of their domicile or residence.
Article 13 All collection units shall do a good job in the collection of basic medical insurance premiums, registration and change of insurance information, assist social insurance agencies to do a good job in the confirmation of insurance information and other related work, and timely turn over the basic medical insurance premiums for urban residents to social insurance agencies, and shall not intercept or misappropriate them.
Fourteenth secondary and technical school students to participate in the basic medical insurance for urban residents, by the municipal social insurance agencies responsible for handling; Other primary and secondary school students, children, elderly urban residents and ordinary urban residents to participate in the basic medical insurance for urban residents, by the district and county social insurance agencies responsible for handling.
Fifteenth basic medical insurance premiums for urban residents shall be paid annually, with a natural year as an insurance year.
Sixteenth urban residents to participate in the basic medical insurance, should pay the basic medical insurance premium in full.
Seventeenth changes in the identity of urban residents, should participate in the corresponding basic medical insurance.
Chapter III Basic Medical Insurance Benefits
Eighteenth urban residents' basic medical insurance fund is supported by income, and the income and expenditure are balanced.
Nineteenth basic medical insurance for urban residents mainly guarantees hospitalization and outpatient medical care for serious and serious diseases, taking into account both general outpatient medical care and emergency medical care.
Twentieth urban residents enjoy basic medical insurance benefits from the month when they go through the insurance payment procedures.
Twenty-first in a year, the maximum payment limit of the basic medical insurance fund for urban residents is 30 thousand yuan.
For urban residents who have not incurred medical expenses in one year, the maximum payment limit of the basic medical insurance pooling fund in the next year will be increased accordingly.
Article 22 The threshold for hospitalization expenses of urban residents participating in basic medical insurance is that they are hospitalized for the first time this year, and the threshold is 300 yuan, a first-class hospital, 500 yuan, a second-class hospital and 700 yuan, a third-class hospital. If you are hospitalized for the second time within one year, the minimum qifubiaozhun will be halved, and if you are hospitalized for the third time, the minimum qifubiaozhun will be cancelled.
Twenty-third to participate in the basic medical insurance for urban residents in designated medical institutions in accordance with the provisions of the hospitalization expenses, according to different levels of hospitals to determine the corresponding reimbursement ratio. Medical expenses incurred in first-,second-and third-class hospitals will be reimbursed by the overall fund in the proportion of 60%, 55% and 50% respectively from the Qifubiaozhun to the highest payment limit.
Urban residents who participate in basic medical insurance will continue to pay fees, and the proportion of reimbursement from the overall fund will increase accordingly.
Article 24 Urban residents participating in the basic medical insurance are confirmed to have malignant tumor (including leukemia), uremia, organ transplantation, diabetes (complicated with infection or one of the complications of heart, kidney, eye and nerve), tertiary hypertension (one of the complications of heart, brain and kidney), rheumatoid disease (active stage), pulmonary heart disease (right heart failure), cerebral hemorrhage (including cerebral infarction), recovery period,
Serious illness outpatient medical expenses are paid in one lump sum within one medical year. Qifubiaozhun in accordance with the provisions of the basic medical insurance for urban workers.
Qifubiaozhun above outpatient serious illness medical expenses, occurred in the designated community health service institutions, paid by the basic medical insurance fund 50%; In other designated medical institutions, the basic medical insurance fund pays 40%.
Within one year, the basic medical insurance pooling fund shall pay the outpatient medical expenses and hospitalization medical expenses for serious illness, and the maximum payment limit shall be implemented in accordance with the provisions of Article 21 of these Measures.
Twenty-fifth urban residents basic medical insurance general outpatient medical expenses to implement community fixed-point quota management, trial outpatient medical expenses as a whole. Urban residents should choose a community health service institution as the designated outpatient medical institution for their general outpatient treatment. Within a year, the general outpatient medical expenses incurred in designated community health service institutions shall be paid by the basic medical insurance pooling fund according to the standard of 15%. In a medical year, the total reimbursement of elderly urban residents and general urban residents shall not exceed that of 40 yuan, and the total reimbursement of primary and secondary school students and children shall not exceed that of 20 yuan. Outpatient medical expenses incurred in non-designated community health service institutions shall not be paid by the basic medical insurance fund.
For urban residents who have not incurred medical expenses within 1 year, the highest reimbursement ratio of general outpatient medical expenses in the next year will be increased accordingly.
Twenty-sixth urban residents who participate in the basic medical insurance need not be hospitalized after emergency treatment for acute, dangerous and serious diseases, and their emergency medical expenses shall be borne by individuals; After the outpatient emergency, the emergency medical expenses that meet the requirements can be incorporated into the hospitalization expenses. Emergency hospitalization medical expenses incurred in non-designated medical institutions in this Municipality shall be settled according to the payment standard of tertiary designated hospitals, and the original invoice, medical record copy, long-term doctor's advice copy, temporary doctor's advice copy and medical expenses summary table shall be provided; Outpatient emergency rescue is invalid, in line with the provisions of the emergency medical expenses, paid by the overall fund 50%.
Article 27 The medical expenses incurred by the personnel enjoying the minimum living guarantee for urban residents in the designated hospitals with special care shall be cancelled, and the others shall be implemented according to the provisions of Article 23 and Article 24 of these measures.
Twenty-eighth urban residents who participate in the basic medical insurance need to be hospitalized in other places due to illness, and have been approved by the social insurance agency. First, the individual shall bear 30% of the medical expenses, and the balance shall be implemented according to the provisions of Article 23 of these Measures.
Chapter IV Management of Medical Services
Twenty-ninth basic medical insurance for urban residents to implement the basic medical insurance for urban workers drug list, diagnosis and treatment project list, medical service facilities and payment standards. Among them, the scope of the catalogue and the payment standards for students and children in primary and secondary schools shall be formulated separately by the municipal labor and social security department, subject to the provisions of the state and the province.
Thirtieth the basic medical insurance fund for urban residents shall not pay the items and contents that meet the relevant provisions of the basic medical insurance for urban workers.
Thirty-first basic medical insurance for urban residents shall be managed by designated medical institutions, and the insured shall go to designated medical institutions for medical treatment. The scope and management measures of designated medical institutions shall be implemented in accordance with the relevant provisions of the basic medical insurance for urban workers.
Thirty-second urban residents general outpatient medical insurance to implement the community designated registration management system. The insured should choose a designated community health service institution as the designated medical institution for my outpatient service; Designated community health service institutions shall timely handle designated registration procedures for the insured. If the insured changes the designated community health service institutions, the designated community health service institutions shall cooperate.
Thirty-third encourage urban residents to seek medical treatment in designated community health service institutions, and try out the system of community first diagnosis and two-way referral, family doctor contact system and family bed system. Specific measures shall be formulated by the municipal labor and social security department in conjunction with the municipal health department. Chapter V Fund Management
Thirty-fourth urban residents' basic medical insurance fund bank interest method in accordance with the relevant provisions of the state, the fund interest income into the overall fund.
Thirty-fifth urban residents' basic medical insurance fund into the social security financial accounts unified management, separate accounting, earmarking, and shall not be misappropriated.
The financial and labor security departments should strengthen the supervision and management of the basic medical insurance fund for urban residents. Audit departments should regularly audit the income and expenditure and management of the basic medical insurance fund for urban residents. Social insurance agencies should strictly implement the social insurance fund budget and final accounts system and financial accounting system.
Thirty-sixth urban residents' basic medical insurance fund revenue and expenditure management, should be regularly reported to the Municipal Social Security Supervision Committee, and regularly announced to the public, accept social supervision.
Chapter VI Supplementary Provisions
Thirty-seventh urban residents' basic medical insurance personal payment and government subsidy standards, treatment standards need to be adjusted, the municipal labor and social security department in conjunction with the municipal finance department put forward specific plans, submitted to the Municipal People's government for approval.
Article 38 These Measures shall come into force as of June 6, 2007.