In 2022, the per capita funding standard of residents' medical insurance shall not be lower than that of 900 yuan, among which the individual payment standard shall be 320 yuan per person, and the total financial subsidies at all levels shall not be lower than that of 580 yuan. Central and local financial subsidies (including provincial, municipal and county financial subsidies) should be fully allocated to the financial special account of Liupanshui medical security fund before the end of 65438+2 every year.
Two, the classification of insurance financing responsibility.
Implement the subsidy policy for groups with special difficulties to participate in insurance. For those with multiple special difficulties, subsidies will be given according to the principle of "high is not low, not repeated enjoyment", and the amount of subsidies will not exceed the annual individual payment standard. Individuals in special groups, after deducting the financial support for life insurance, only need to pay the self-paid part of life insurance. In 2022, the specific targets and standards for subsidizing the insured are:
(A) the target of fixed funding
1. The poverty-stricken population (the original poverty-stricken population who set up a file and set up a card) is still subsidized according to the standard of 140 yuan per person per year. According to the spirit of the document Guiding Opinions of Guizhou Provincial Party Committee and Guizhou Provincial People's Government on Promoting Rural Revitalization by Classification (Guizhou Dangzhengfa [202 1] 14), the consolidation of basic counties (Shuicheng District) shall be fully borne by the provincial finance; Focus on promoting counties (Liuzhi Special Zone), which will be shared by provinces, cities and counties according to the ratio of 5:2:3; The leading demonstration county (Panzhou City) was originally a general poverty-stricken county, which was shared by provinces, cities and counties according to the ratio of 5:2:3; Leading demonstration counties (including five towns in the north of Zhongshan District), as original non-poverty counties, shall be fully borne by county-level finance.
2. Marginal poor households shall be funded according to the Notice of Guizhou Provincial Taxation Bureau of Provincial Medical Insurance Bureau on Doing a Good Job of Marginal Population Participating in Medical Insurance for Urban and Rural Residents (No.40 [2020] of Guizhou Medical Insurance), and the funding shall be borne by the county-level finance.
3. The individual contributions of low-income residents are partially funded by the medical assistance fund according to the standard of 140 yuan per person per year. The individual contributions of the elderly, minors, severely disabled and seriously ill patients in low-income families shall be funded by the medical assistance fund according to the standard of 60 yuan per person per year.
(2) Full-funded objects
1. Family planning "two households" and individual family members with special family planning will continue to implement the full subsidy policy, and the required funds will be fully borne by the county finance.
2. The individual contributions of poor people (orphans, children who are actually neglected), retired old workers in the early 1960s, and mentally handicapped patients who make troubles are fully funded by the medical assistance fund.
For other people with special difficulties other than the above-mentioned funding targets, the funding standards shall be clearly defined by all localities according to the central and provincial policy documents and the actual situation.
Third, standardize the collection standards and treatment of residents' medical insurance (1) Time limit for collection
In 2022, the individual payment of residents' medical insurance will be mainly centralized payment, supplemented by sporadic payment. The collection period is divided into centralized collection period and sporadic collection period.
1. Centralized collection period. 2021end of September to March 3, 20221.
2. Sporadic collection period. The period of sporadic collection of dynamic insurance policies for specific disadvantaged groups is from April 1 day to February 3 1 day, 2022; The general public and vulnerable groups who do not enjoy dynamic insurance policies will receive them sporadically from April 1 day to October 3 1 day.
(2) Payment standard and treatment
1. Ordinary people. Ordinary people who paid residents' medical insurance premiums in 2022 during the centralized collection period will pay insurance premiums according to 320 yuan standards and enjoy residents' medical insurance benefits from June 65438+ 10/day, 2022. In the sporadic collection period, residents' medical insurance premiums in 2022 will be paid, and the insurance premiums will be paid according to 900 yuan standards, and residents' medical insurance benefits will be enjoyed after 60 days (excluding 60 days) from the payment date.
2. The low-income recipients, poor people, marginal poor households, elderly people in low-income families, minors, severely disabled and seriously ill patients, destitute people, orphans, children with virtually no dependents, family members of "two families" in family planning, retired old workers who were downsized in the early 1960s, and patients with mental disorders who caused troubles were dynamically insured throughout the year, and the payment was not limited by the centralized collection period, and they enjoyed the subsidy insurance policy. Those who pay fees during the centralized collection period will enjoy medical insurance benefits for residents from 1 2022; Sporadic collection period payment, enjoy residents' medical insurance benefits from the date of payment.
3 other groups with special difficulties do not implement the dynamic insurance policy. Enjoy the subsidized insurance policy during the centralized collection period, pay the insurance premium according to the amount of 320 yuan minus the local government-funded insurance funds, and enjoy the residents' medical insurance benefits on June 65438+1 October1day, 2022; If the payment is made sporadically during the period, the insurance premium shall be paid according to 900 yuan, and residents' medical insurance benefits shall be enjoyed after 60 days (excluding 60 days) from the date of payment.
4. Retired soldiers and their spouses. Unemployed spouses in the army in the year when soldiers retired from active service and in the year when soldiers retired from active service participated in residents' medical insurance and participated in the annual dynamic insurance. Payment is not restricted by the centralized collection period, and the insurance premium is paid according to the standard of 320 yuan. Those who pay in the centralized collection period will enjoy medical insurance benefits for residents from June 65438+1 October1day, 2022; Sporadic collection period payment, enjoy residents' medical insurance benefits from the date of payment.
5. Newborns. A 90-day dynamic policy is implemented in the year of birth. During the sporadic collection period, within 90 days (including 90 days) from the date of birth of the newborn, if the household registration information is used for insurance registration and payment, the insurance premium shall be paid according to 320 yuan, and residents shall enjoy medical insurance benefits from the date of birth; If the insurance premium is paid after 90 days (excluding 90 days) from the date of birth, the insurance premium shall be paid according to 900 yuan, and the residents shall enjoy medical insurance benefits after 60 days (excluding 60 days) from the date of payment.
For newborns who do not use household registration information to pay insurance premiums, the medical expenses incurred since the date of birth can be included in the scope of medical insurance reimbursement after the guardian improves his identity information.
If the newborn dies after birth and the guardian pays the insurance money within 90 days from the date of birth, the medical expenses incurred after birth shall be settled according to the policy. Local medical insurance departments and tax authorities continue to provide relevant handling services in accordance with the relevant provisions of document No.53 [2020] of Guizhou Medical Insurance.
6. Workers' medical insurance will be transferred to residents' medical insurance personnel, and a 90-day dynamic insurance policy will be implemented. Those who participate in employee medical insurance can participate in residents' medical insurance within 90 days (including 90 days) after the suspension of employee medical insurance, pay insurance premiums according to 320 yuan standards, and enjoy residents' medical insurance benefits from the date of payment; If the payment exceeds 90 days (excluding 90 days), the insurance premium shall be paid according to the standard of 900 yuan, and residents shall enjoy medical insurance benefits after 60 days (excluding 60 days) from the date of payment.
7. In principle, college students take the school as the unit and participate in residents' medical insurance at the school location. If you are a group with special difficulties who enjoy government-funded insurance, you can choose to participate in school registration or identity recognition and enjoy medical insurance benefits according to regulations.
Fourth, take multiple measures to promote the expansion of insurance coverage.
(1) Various groups with special difficulties. Accurately lock in the participation of groups with special difficulties. County-level medical insurance and taxation departments should make good use of local cooperation mechanisms and organize relevant functional departments at the same level to provide timely lists of groups with special difficulties. County-level medical insurance departments should keep abreast of the payment of special people. For fully funded personnel, the county-level tax authorities should promptly import the information of fully funded personnel into the social security premium standard version system to complete zero declaration. The county-level medical insurance bureau departments shall open medical insurance benefits in the medical insurance information system according to the zero declaration data fed back by the tax authorities at the same level. For the personnel with fixed subsidies, the medical insurance and taxation departments should accurately identify their identities and set collection standards to ensure that people with special difficulties can enjoy government subsidies in time when they join the insurance. Regularly sort out the list of uninsured groups with special difficulties, timely organize publicity and mobilization, and assist them to participate in insurance through multi-channel tax payment.
(2) Students (including preschool children attending kindergartens). All localities should actively coordinate the education departments, strive to fully grasp the situation of students in the city in 20021,find out the enrollment base, make precise policies, and publicize and mobilize. At the same time, combined with local conditions, we will work with the education department to simplify the personal information registration process. Medical insurance and taxation departments at all levels strive for school support to the maximum extent, move the service window forward, and boost students' participation in insurance.
Five, improve the ability of handling services
(1) Improve the accuracy of registration information. Give full play to the role of grassroots medical insurance managers and collectors, and do a good job of comparing and inputting the basic information of newly added and changed insured individuals. The personal information of migrant workers in the insured area is registered and entered, and the working people can apply for insurance registration with relevant certificates (ID card, household registration book, etc.). ) can prove its complete and true identity information. When entering the information of the new insured, ensure that the name and identity information of the insured are consistent with the public security household registration, except for special personnel who have no identity information for the time being, such as newborns, prisoners and foreign brides who have legally entered the country.
(2) Do a good job in identifying difficult groups. According to the "Notice on Doing a Good Job in Paying the Basic Medical Insurance Fee for Urban and Rural Residents for Special Groups, such as the Poverty-stricken People" (No.2019102 of Guizhou State Administration of Taxation), the county-level medical insurance and tax authorities should take the lead in implementing the government funding standards, funding channels and personnel list for the disadvantaged groups in the region when they join the insurance, do a good job in setting up special groups' logos, and timely implement the individual insurance payment assistance work.
(3) Do a good job in mass insurance services. Increase the business training for medical insurance handling personnel, so that medical insurance handling personnel can master the collection policy and key points, and improve their business level and handling ability. Combined with the actual local collection work, carefully collect and sort out the common problems in the "integrated" registration system or mass payment insurance, establish a work ledger, form a unified handling process and explanation caliber, and improve the handling efficiency and mass satisfaction. For the disabled, the elderly and other special insured persons with mobility difficulties, provide convenience and benefit services, open a "green channel" in the window during the centralized collection period or assign someone to take the initiative to enter the home to assist them in handling the "one-stop" service of insurance registration and payment. Improve the popularization and application rate of medical insurance in electronic certificate, give full play to the advantages of medical insurance electronic certificate in terms of convenience and rapidity in insurance payment, medical treatment and drug purchase, and further provide convenience for the insured people.
(1) Improve the accuracy of registration information. Give full play to the role of primary health insurance managers and collectors, and do a good job of comparing and inputting the basic information of newly added and changed insured individuals. The personal information of migrant workers in the insured area is registered and entered, and the working people can apply for insurance registration with relevant certificates (ID card, household registration book, etc.). ) can prove its complete and true identity information. When entering the information of the new insured, ensure that the name and identity information of the insured are consistent with the public security household registration, except for special personnel who have no identity information for the time being, such as newborns, prisoners and foreign brides who have legally entered the country.
(2) Do a good job in identifying difficult groups. According to the "Notice on Doing a Good Job in Paying the Basic Medical Insurance Fee for Urban and Rural Residents for Special Groups, such as the Poverty-stricken People" (No.2019102 of Guizhou State Administration of Taxation), the county-level medical insurance and tax authorities should take the lead in implementing the government funding standards, funding channels and personnel list for the disadvantaged groups in the region when they join the insurance, do a good job in setting up special groups' logos, and timely implement the individual insurance payment assistance work.
(3) Do a good job in mass insurance services. Increase the business training for medical insurance handling personnel, so that medical insurance handling personnel can master the collection policy and key points, and improve their business level and handling ability. Combined with the actual local collection work, carefully collect and sort out the common problems in the "integrated" registration system or mass payment insurance, establish a work ledger, form a unified handling process and explanation caliber, and improve the handling efficiency and mass satisfaction. For the disabled, the elderly and other special insured persons with mobility difficulties, provide convenience and benefit services, open a "green channel" in the window during the centralized collection period or assign someone to take the initiative to enter the home to assist them in handling the "one-stop" service of insurance registration and payment. Improve the popularization and application rate of medical insurance in electronic certificate, give full play to the advantages of medical insurance electronic certificate in terms of convenience and rapidity in insurance payment, medical treatment and drug purchase, and further provide convenience for the insured people.
(4) put an end to repeated insurance. Using the data interconnection function of medical insurance and tax information system, the problem of repeated participation in the province or across systems can be fundamentally solved. With the identity information of the insured as the only control condition, the same identity information can only be controlled to participate in the medical insurance for residents once in the province. Due to special reasons such as new job, transfer, further studies, resettlement in different places, etc., it is necessary to change the insurance category or relationship in different places in the province, and the medical insurance department should do a good job in relevant handling services to ensure the smooth continuation of the medical insurance benefits of the insured in the province.
(5) Do a good job of refund. If the insured person dies after paying the residents' medical insurance, pays the medical insurance repeatedly or gets the medical insurance by mistake for other reasons, the medical insurance and taxation departments shall follow the Notice of Guizhou Provincial Medical Security Bureau of Guizhou Provincial Department of Finance, Guizhou Provincial Taxation Bureau, State Taxation Administration of The People's Republic of China City, People's Republic of China (PRC) (No.6 [2020] of Guizhou State Administration of Taxation). At the same time, you can terminate the medical insurance participation relationship of the relevant residents and apply for a refund for the individual according to the application.
Work requirements of intransitive verbs
(1) Carefully organized and implemented. County-level medical insurance and tax departments shall, in accordance with the requirements of this notice, draw the people's government at the county level to strengthen organizational leadership as soon as possible, make overall plans to promote the work, and hold a fund-raising kick-off meeting in the name of the government. At the same time, this work should be included in the agenda of the Party committee and government as an important task at present, further strengthen organizational leadership, implement responsibilities, establish and improve the working mechanism, and form a leadership working mechanism in which the main leaders personally grasp, the leaders in charge specifically grasp and implement at different levels. The number of insured persons collected by all localities shall not be less than the number of insured persons at the end of June 20021year.
(2) Close cooperation. Medical insurance and tax departments at all levels should strengthen the division of labor and cooperation, and perform their duties according to their respective responsibilities. First of all, all departments work together to urge the local government to move closer to towns and villages.
Street organizations participate in insurance and collect and pay taxes. Second, the tax authorities should do a good job in system setting and premium collection according to the special group identification information and out-of-pocket insurance information transmitted by the medical insurance department. The third is to establish a reconciliation mechanism to ensure the smooth and reliable exchange of payment details. Fourth, the medical insurance department continues to do a good job in the registration of personal identity information of new and floating personnel and the opening of medical insurance benefits by using the integrated collection system. Fifth, the medical insurance department cooperates with taxation and other relevant departments to declare the financial subsidy funds for medical insurance for residents at all levels on time and in full.
(3) Do a good job in publicity and guidance. All localities should follow the provisions of the People's Republic of China (PRC) Basic Medical Care and Health Promotion Law, "Citizens have the right and obligation to participate in basic medical insurance according to law. Employers and employees pay basic medical insurance premiums for employees in accordance with state regulations. Urban and rural residents pay the basic medical insurance premiums for urban and rural residents in accordance with the regulations, do a good job in publicizing the payment of insurance according to law, innovate publicity methods, expand publicity channels, and make policies clear and thorough. Especially for the adjustment of individual financing standard of medical insurance, it is necessary to clarify individual payment responsibility in the system, highlight the concept of medical insurance * * * building * * * to enjoy and help each other * * * economy, guide social expectations, create a good external environment for residents' medical insurance collection and payment in 2022, make the people truly understand and fully support the financing reform, mobilize the enthusiasm of the people to participate in payment, and promote the smooth development of collection and payment.
(4) Strengthen supervision and dispatch. All localities should implement a regular notification system, timely notify the progress of insurance work according to the number of payers registered in the collection system, and rank according to the completion of tasks. For counties (districts) and towns (streets) with ineffective measures and lagging progress, special personnel will be sent to conduct on-the-spot investigation and guidance to help them find out problems, sort out difficulties, and constantly fill in shortcomings in their work. Summarize the effective work practices of counties (districts) and towns (streets) with good progress in collection and payment, and promote them in time.