If the employee's basic medical insurance premium is interrupted or unpaid beyond the prescribed time limit, the employee's basic medical insurance benefits will be suspended, and the basic medical insurance premium during the interruption or unpaid period can be paid back, and the treatment during the interruption after payment will be implemented according to the relevant regulations.
Article 14 When employees participating in the basic medical insurance for employees in this Municipality reach the statutory retirement age, the cumulative payment period shall be no less than 30 years for men and 25 years for women, and no less than 10 year for this Municipality. After retirement, employees will no longer pay the basic medical insurance premium and continue to enjoy the basic medical insurance benefits for employees. If the payment period has not been reached, you can enjoy the basic medical insurance benefits for retired workers after making up the basic medical insurance premium in a lump sum in accordance with the regulations; You can also choose to enjoy the basic medical insurance benefits for retired employees after the payment of employees has reached the specified number of years; Is the introduction of special talents, in accordance with the relevant provisions.
If an employee is employed across the overall planning area, his basic medical insurance relationship will be transferred with himself, and the payment period of the original employee's basic medical insurance will be calculated cumulatively.
Fifteenth insured persons can switch different types of insurance in accordance with the provisions and enjoy the corresponding medical insurance benefits, but the basic medical insurance premium paid before the switch will not be refunded.
Sixteenth people who participate in the basic medical insurance for urban and rural residents shall enjoy the medical insurance benefits for urban and rural residents during the payment period. If the time for newborns to enjoy treatment is otherwise stipulated, it shall be implemented in accordance with relevant regulations.
Seventeenth insured persons in accordance with the relevant provisions to enjoy hospitalization, outpatient (emergency) diagnosis of common diseases and outpatient special diseases, special chronic diseases and other medical expenses reimbursement treatment.
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue reimbursement scope shall be paid by the social medical insurance fund in accordance with the relevant provisions, except for one of the following circumstances:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Going abroad for medical treatment;
(five) other laws and regulations shall not pay the fees.
The medical expenses that should be borne by the third party according to law, if the third party is unable to pay or can't determine the third party, shall be paid by the social medical insurance fund in advance. After the social medical insurance fund pays in advance, it has the right to recover from the third party according to law.
Article 18 The setting and adjustment of the minimum threshold, maximum payment limit and payment proportion of the social medical insurance pooling fund shall be submitted for approval in accordance with the relevant provisions.
Nineteenth to encourage the insured to primary medical and health service institutions. The social medical insurance pooling fund shall pay a higher proportion of the medical expenses incurred by the insured in the designated primary medical and health service institutions than other designated medical institutions.