Detailed explanation of the implementation measures of basic medical insurance for urban and rural residents in Shijiazhuang
Overall planning model of residents' medical insurance
In accordance with the principle of * * * hierarchical management and risk adjustment between counties, the urban and rural residents' basic medical insurance system with unified coverage, unified financing policy, unified security treatment, unified medical insurance catalogue, unified fixed-point management and unified fund management will be gradually established. At the same time, establish serious illness insurance and accidental injury insurance for urban and rural residents.
Basic principles adhered to in the "Implementation Measures"
The income is fixed, the income and expenditure are balanced, and there is a slight balance; Individual contributions are combined with * * * subsidies; Be based on the basics, ensure fairness and make overall plans; Adhere to sustainable development, and the financing standard and guarantee level are compatible with the city's economic and social development. Focus on ensuring hospitalization and giving consideration to outpatient medical care.
Security object
These Measures shall apply to the following security objects within the administrative area of this Municipality:
Urban and rural residents with household registration in this city and not included in the basic medical insurance system for urban workers.
Primary and middle school students studying in primary and secondary schools in this city and not participating in medical insurance for urban and rural residents in their original place of residence.
Within the administrative area of this Municipality, all kinds of full-time ordinary colleges and universities * * * include scientific research institutes, scientific research institutes * * * and technical secondary schools * * * hereinafter referred to as college students * * *.
Foreign businessmen and migrant workers who have obtained the residence permit of this Municipality and have not participated in the basic medical insurance in their places of origin shall participate in the basic medical insurance for urban workers according to law. If there are difficulties, they may voluntarily participate in the medical insurance for urban and rural residents according to the relevant provisions of this Municipality, and their minor children who are not insured in their place of origin may also participate in the medical insurance for urban and rural residents in this Municipality.
Registration
Medical insurance for urban and rural residents is paid in advance once a year, and medical treatment is paid once a year. From 20 16, 12, 1 to 20 17, the enrollment and payment of 20 17 will be handled centrally. In the future, the time for urban and rural residents to pay insurance will be from September 1 day to February 25 of that year.
It's the first time to take the household registration book, ID card * * * residence permit * * * to the neighborhood committee or village committee to register for insurance. Urban and rural residents who meet the conditions of insurance in the same household registration book should all be insured as a family.
Urban and rural residents who have newly moved into the household registration shall register and pay the insurance within 3 months from the date of settlement, and enjoy medical insurance benefits from the date of payment. Newborns registered in this Municipality shall, within 3 months from the date of birth, apply for insurance registration and payment at the place where they are registered, and enjoy medical insurance benefits from the date of birth.
The school is responsible for college students' enrollment registration and fees, and collects and submits their medical insurance information according to the requirements of insurance agencies.
Five-guarantee recipients, low-income recipients, first-and second-class disabled residents who have lost their ability to work, elderly people over 60 years old, minors from low-income families and other urban and rural residents who meet the funding conditions of * * * *, should also produce relevant certification materials issued by relevant departments when handling insurance registration. Sub-district offices, township * * * * * *, neighborhood committees and village committees shall strictly examine relevant documents and materials, publicize them within their respective jurisdictions, and accept supervision by the masses.
The insured urban and rural residents no longer belong to medical insurance coverage, an urban and rural resident of our city, for reasons such as joining the army, employment, non-graduation reasons, ending school life, enrollment, and moving out of the city. , should be based on the relevant certification materials to cancel its medical insurance relationship. During the non-treatment period, the medical insurance premium paid in that year will be refunded.
If the insured urban and rural residents die, the medical insurance relationship shall be terminated, and the relatives shall cancel their medical insurance relationship in the insurance agency. If the medical insurance relationship is terminated during the non-treatment period, the medical insurance premium paid in the current year will be refunded.
Raising the basic medical insurance fund
Medical insurance for urban and rural residents shall be financed by combining individual contributions and subsidies, and collectives, units or other social and economic organizations shall be encouraged to give support or funding.
In 20 17 years, the individual payment standard for urban and rural residents is: per person in * * county and * * city 180 yuan; Everyone in the urban area pays 240 yuan.
In 20 16, the new college students paid the fees according to the standard of 40 yuan, among which the individual paid 20 yuan and the municipal financial subsidy 20 yuan. From 20 17, except for college students who pay medical insurance premiums for the whole school year, the individual payment standard shall not be lower than that stipulated in document No.20 of Ji [2016]. On the basis of general financial subsidies, the municipal finance gives 20 yuan subsidies to the individual contributions of each insured college student.
medical insurance
Compared with the original policy before integration, the overall treatment of medical insurance for urban and rural residents has improved. Mainly reflected in the following aspects:
Give priority to ensuring hospitalization and give consideration to outpatient needs. On the premise of ensuring hospitalization medical expenses, a lump-sum system for general outpatient expenses has been established. Except for urban and rural residents and college students, general outpatient medical expenses are included in the social security card according to the 40 yuan standard per person per year. The annual balance does not bear interest, but can be carried forward and inherited. At the same time, taking into account the medical needs of people with chronic diseases, special outpatient diseases, first aid for critically ill patients and special outpatient drugs, the city has unified outpatient treatment for such people.
The overall medical treatment is high and low. The number of rural residents in the hospitalization deductible period of medical institutions at all levels decreased; The reimbursement rate of rural residents in tertiary medical institutions has increased by 10%- 15%, and the average reimbursement rate of urban residents in medical institutions at all levels has also increased by 5 percentage points; The number of chronic diseases has been expanded from 9 to 20, and the number of outpatient special diseases has been expanded from 4 to 7, and the reimbursement limit and proportion have been increased. At the same time, the regulations on increasing the reimbursement ratio of continuous insurance contributions were unified.
The list of drugs is wide or narrow. After the introduction of the medical insurance policy for urban and rural residents, the original new drug list of the new rural cooperative medical system will be expanded from the original 1 100 to 2600, and the scope of drug reimbursement for rural residents will be greatly improved. It solves the problem that there are few optional drugs for medical treatment at the grassroots level, greatly narrows the gap between the actual medical expenses and the reimbursement amount, and the insured will get tangible benefits.
The scope of medical care has gradually expanded. After the integration of the system, the scope of medical treatment for insured residents in * * * county and * * city will be gradually expanded, the procedures for referral and transfer will be further simplified, and the management of medical treatment will be gradually unified. Insured residents in municipal districts can declare immediately after hospitalization, which reduces the pressure of personal advance payment and the workload of reimbursement.
Realize the organic integration of basic medical insurance and serious illness medical insurance. After the introduction of the medical insurance policy for urban and rural residents, the insured urban and rural residents will seek medical treatment in designated medical institutions, which will realize the "one-stop" reimbursement of basic medical insurance and serious illness insurance.
payment types/methods
County * * * city * * payment method remains unchanged; All districts in the city can pay fees through Hebei Bank, which, as the only payment institution in the urban area, provides five payment methods for insured residents to choose from:
Mobile banking is convenient for payment and never leaves home. Need to download and install the mobile banking of Hebei Bank. After downloading the mobile banking client, you can register your own mobile banking without going to the business outlets. Self-registered mobile banking has the function of paying living expenses. In addition to paying medical insurance for urban and rural residents, you can also pay heating fees, cable TV fees, telephone fees and other functions.
Personal online banking, convenient payment without leaving home.
Self-service multimedia machines need to be handled at business outlets.
ATM machines need to be handled at business outlets.
Hebei province promotes the integration of the basic medical insurance system for urban and rural residents in the province.
China Economic Net Shijiazhuang June 1 News On June 1, Hebei Province held a video conference on the deployment of the basic medical insurance system for urban and rural residents, and arranged to promote the integration of the basic medical insurance system for urban and rural residents in the province. Yuan Tongli, deputy governor of Hebei Province and deputy secretary of the Party Group, made arrangements for the integration of the basic medical insurance system for urban and rural residents in the province. Jiang Deguo, deputy governor of Hebei Province, conveyed the implementation opinions of the People's Government of Hebei Province on the integration of the basic medical insurance system for urban and rural residents. Zhu Haowen, Secretary-General of the People's Government of Hebei Province, presided over the meeting and read out Governor Zhang's instructions on integrating the basic medical insurance system for urban and rural residents in Hebei Province.
The meeting pointed out that establishing a unified basic medical insurance system for urban and rural residents in accordance with the requirements of the Party and the Third and Fifth Plenary Sessions of the Eighteenth Central Committee is an important measure to promote the reform of the medical and health system in Hebei Province, realize the rights and interests of urban and rural residents to enjoy basic medical insurance, and enhance people's well-being. At present, Hebei Province has established a wide coverage and multi-level medical insurance system. The participation rate of rural residents and urban residents in medical insurance reached more than 95%, and the actual number of participants was nearly 70 million, which basically solved the problem of "everyone enjoys". It is the essential requirement of building a well-off society in an all-round way to promote the integration of medical insurance system for urban and rural residents, build a medical insurance system for urban and rural residents with fairer guarantee, more standardized management services and more effective utilization of medical resources, especially to realize the "fair enjoyment" of rural residents and urban residents in terms of insurance payment, drug list and actual medical services.
The meeting requested that all localities and departments should stand at the height of the overall reform and development of the province, fully understand the great significance of doing a good job in integrating the basic medical insurance system for urban and rural residents, seize the key points, make precise efforts, and strive to improve the pertinence and effectiveness of the system integration work. According to the "Implementation Opinions of the People's Government of Hebei Province on Integrating the Basic Medical Insurance System for Urban and Rural Residents", the objectives and tasks should be clarified, the implementation measures should be refined, and the safeguard measures should be improved. Ensure that the functions, establishment and personnel are integrated before the end of July, organize urban and rural residents to pay insurance premiums according to the unified policy from September 1, and implement the new policy from September 20 17 to 65438+1 October1.
The meeting stressed that the integration of the basic medical insurance system for urban and rural residents is a complex systematic project, and all localities and relevant departments should attach great importance to it, make careful plans and scientific arrangements, and earnestly do a good job in this project of benefiting the people. The province * * * has set up a leading group for integration work headed by relevant leaders, and cities and counties should also set up corresponding institutions to coordinate their work. People's organizations, health and family planning, development and reform, organization, finance, civil affairs, auditing, education and insurance supervision departments at all levels should closely cooperate and jointly promote. Discipline inspection and audit should supervise the whole process of system integration, promote the smooth connection of medical insurance handling services, and ensure that the medical needs of the people such as medical treatment are not affected.
A few days ago, the People's Government of Hebei Province issued the "Implementation Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents", clearly stating that a "six unified" basic medical insurance policy system for urban and rural residents will be established in the province. The first is unified coverage. The coverage of the medical insurance system for urban and rural residents includes the existing medical insurance for urban residents and all insured persons of the new rural cooperative medical system. Residents participate in urban and rural residents' medical insurance with their families and students at school as the basic information, and the annual payment system is implemented. The second is to unify the financing policy. The implementation of individual contributions and * * * subsidies to combine financing methods, and encourage collectives, units or other social and economic organizations to give support or funding. Individuals * * * including students * * * in the overall planning area shall implement a unified payment standard. The third is unified protection and treatment. In accordance with the principle of moderate security and balance of payments, the scope of security and payment standards will be gradually unified. We will implement a unified serious illness insurance system for urban and rural residents, keep the proportion of hospitalization medical expenses paid for serious illness insurance above 50% within the scope of the policy, and promote provincial-level co-ordination of serious illness insurance. Combined calculation of residents' insurance years before and after integration. The fourth is to unify the basic medical insurance catalogue. Merge the existing urban residents' medical insurance and the catalogue of drugs, diagnosis and treatment projects and medical service facilities of the new rural cooperative medical system, and establish a unified catalogue of basic medical insurance in the province. 20 16 urban and rural residents' medical insurance payment scope temporarily implements the scope of the original urban residents' medical insurance and the new rural cooperative medical system drugs, diagnosis and treatment projects and medical service facilities; The overall planning area that has completed the integration of medical insurance for urban and rural residents shall be implemented according to the current policy. The fifth is unified fixed-point management. According to the principle of first inclusion and then unification, the original urban residents' medical insurance and new rural cooperative medical institutions will be integrated into the designated scope of urban and rural residents' medical insurance. Sixth, unified fund management. The urban residents' medical insurance, the balance fund of the new rural cooperative medical system over the years, the risk fund and the current collection fund will be merged into the urban and rural residents' medical insurance fund, which will be included in the financial special account of the social security fund, and unified management of revenue and expenditure will be implemented. No unit or individual may misappropriate it.
The "Implementation Opinions" proposes to unify the management system and institutional policies and transfer the administrative and management service functions of the new rural cooperative medical system to the human resources and social security departments. First integrate institutions, personnel, funds, etc. And then integrate institutional policies. In the process of the integration of the two systems, the existing policies and management systems shall not be adjusted in the overall planning areas at all levels.