The payment standard for children's medical insurance in Shenzhen is tentatively set at 150 yuan per person per year. Implement the principle of * * * financial and children's families sharing the burden. The finance subsidizes 75 yuan every year, and children's families pay 75 yuan every year. For low-income families with difficulties, referring to the method of low-income workers participating in social insurance, the Civil Affairs Bureau will handle the insurance procedures in a unified way, and the expenses will be paid by Welfare Lottery Fund to ensure that all insured children are included in the children's medical insurance system.

Legal objectivity:

Adopted the Trial Measures for Medical Insurance for Inpatients and Serious Illness Outpatients in Shenzhen (draft, hereinafter referred to as the Measures). It means that the formal establishment of Shenzhen's children's medical insurance system marks that the solution of children's medical security problems in our city has institutional guarantee. The establishment of children's medical insurance system is one of the ten livelihood facts solemnly promised in the "Government Work Report" of the two sessions at the beginning of this year. The municipal party Committee and municipal government attached great importance to it and actively supervised it. Led by the Municipal Labor and Social Security Bureau, with the active participation of the Municipal Health Bureau, the Municipal Education Bureau, the Municipal Finance Bureau and other departments, after in-depth investigation and demonstration, the opinions of various functional departments and all sectors of society were widely solicited. During the period, the draft was revised several times, which made the measures more in line with the actual situation of our city and matched the economic development level of our city, effectively solving the problem of children's medical security. The significance of the promulgation of the Measures lies in: 1. The Municipal Party Committee and the Municipal Government attach great importance to and vigorously promote the establishment of the children's medical insurance system, which fully embodies the concern for the healthy growth of children in our city. Second, the level of treatment stipulated in the Measures is relatively the highest among the cities that have established children's medical insurance in China, and it focuses on protecting seriously ill and seriously ill children, so that children's medical insurance has a real guarantee significance. Third, the government increased financial subsidies, and finally decided to subsidize half of the total cost 150 yuan, that is, each person subsidizes 75 yuan every year, which is the highest in the country. The rest of 75 yuan is paid by the children's families, that is, only 6.25 yuan per month can make the children get better medical security. Four, the "measures" do not set the threshold of household registration, and include the children of migrant workers in the scope of insurance, which reflects the concern of the municipal party Committee and the whole society for migrant workers and is conducive to social fairness and social harmony. V. The establishment of the children's medical insurance system marks that our city has taken the lead in realizing "universal medical insurance" in the country. Our city has been actively exploring the establishment of a universal medical insurance model with Shenzhen characteristics, which is characterized by multi-level, wide coverage and good treatment. Comprehensive medical insurance, hospitalization medical insurance, labor medical insurance and children's medical insurance covering all citizens are expected to reach 7.5 million by the end of this year. Background information and main contents of "Trial Measures for Medical Insurance for Inpatients and Serious Illness Outpatients in Shenzhen": 1. Necessity of establishing children's medical insurance (1) There is a high demand for establishing children's medical insurance from all walks of life. At present, the city has established a medical insurance system for urban workers and laborers, but children have no medical insurance. In order to effectively solve the financial difficulties of families with seriously ill children and prevent poverty caused by illness, it is urgent to establish a medical security system for children. For many years, the public has been calling for the establishment of medical security for children and adolescents. The news media and NPC representatives are also very concerned about this. At the two sessions in 2004, Wu et al. 1 1 representatives jointly put forward the proposal of establishing Shenzhen Children's Medical Insurance Fund. After five years of investigation, Shenzhen labor and social security department has come up with the method of children's medical insurance. (2) Beijing, Shanghai, Suzhou, Zhuhai and other large and medium-sized cities have established children's medical security systems. At present, many cities across the country have established children's medical security systems. There are two main modes. One is the model of Beijing and Shanghai with the Red Cross as the agency. The other is the model represented by Suzhou, with social insurance institutions as the handling agencies. Zhuhai and Dongguan in the province have also established a children's hospitalization insurance system. As a window of national reform and opening up, Shenzhen has fallen behind in this respect, and it is necessary to establish a children's medical insurance system as soon as possible. Two. The main contents of the Measures (1) Coverage The registered students (including students with deep household registration and students without deep household registration) in kindergartens of primary and secondary schools in this city, as well as registered children under 65,438+08 who are not enrolled in the park or have not settled outside the city and meet the family planning policy, should participate in children's medical insurance. At the same time, in order to prevent problems such as nominal insurance, the Notice of Shenzhen Municipality on Several Opinions and Five Supporting Documents on Strengthening and Perfecting Population Management is strictly implemented, stipulating that children who are not registered in this city and are studying in primary and secondary schools and kindergartens in our city can only be insured if either parent has participated in social insurance in this city for more than 1 year. It is understood that there are about1.000 registered children under the age of 0.8 in kindergartens in primary and secondary schools in the city. The specific distribution is as follows: the number of kindergartens, primary schools and middle schools is 954,458, of which 352,542 are registered in Shenzhen, and the number of kindergartens, primary schools and middle schools for children who are not registered in Shenzhen is 60 19 16 (accounting for 63./kloc-). (two) to take the government to actively guide, vigorously promote, social security agencies to handle the model. The Ministry of Labor and Social Security encourages qualified cities to introduce measures for children's medical insurance, and the state is stepping up the formulation of pilot measures for children's medical insurance. Moreover, many cities in China, such as Suzhou, Zhenjiang, Zhuhai, etc., have introduced children's medical insurance systems and established funds within the framework of social medical insurance. Therefore, the introduction of the children's medical insurance model in our city, which is actively guided by the government, compulsory insurance, and strongly implemented by social security agencies and funds, conforms to national policies. (three) the scope of payment set by the children's medical insurance fund includes the basic medical expenses incurred in hospitalization and serious illness clinics, excluding the general outpatient expenses and ultra-basic medical expenses. In order to avoid minor illness hospitalization, children's medical insurance has set hospitalization Qifubiaozhun, which is 300-600 yuan according to the principle of guiding decentralized medical treatment and designating different levels of medical units. Children's medical insurance has also set an annual maximum payment limit of 200,000 yuan, which is linked to the time of continuous participation in children's medical insurance. The proportion of medical expenses paid has been greatly increased, and it is stipulated that the basic medical expenses above the deductible line and within the maximum payment limit for each hospitalization of the insured, or within the maximum payment limit for each serious illness clinic, shall be paid by the Children's Medical Insurance Fund according to the following standards: if the basic medical expenses are less than 5,000 yuan, the fund will pay 80%; 5000 yuan to 10000 yuan, and the fund pays 85%; /kloc-90% for funds above 0/0000 yuan. For example (all within the scope of children's medical insurance payment), children's hospitalization expenses of 5,000 yuan can be reimbursed for 3,760 yuan, expenses of 30,000 yuan can be reimbursed for 25,980 yuan, and expenses of 200,000 yuan can be reimbursed for178,980 yuan. The survey results show that hospitalization, especially serious illness hospitalization, is the main cause of poverty caused by illness. The children's medical insurance measures implemented in various places do not stipulate outpatient treatment, so the children's medical insurance fund does not pay for general outpatient treatment. For children's general outpatient expenses, reform the social medical insurance measures for urban workers, implement family subsidies for children's general outpatient expenses, and mix them with parents' personal medical insurance accounts. (4) The payment standard is tentatively set as 150 yuan/year/person. The principle of sharing the burden between finance and children's families is implemented. The finance subsidizes 75 yuan and children's families subsidize 75 yuan every year, which means that children's families can get medical insurance as long as they pay 6.25 yuan per month, without affecting their economic situation. For low-income families with difficulties, the Civil Affairs Bureau shall handle the insurance procedures in a unified way with reference to the way for low-income people to participate in social insurance, and the expenses shall be paid by the welfare lottery fund. (5) Agency and management: Children's medical insurance premiums are collected by social security agencies. Every September, the municipal social insurance agency collects fees from schools and child care institutions, and the school actively assists and cooperates. Children who are not registered in the city, their parents or legal guardians shall go to the municipal social insurance institution for insurance and payment procedures in September each year with the household registration book. (six) enjoy and stop enjoying the benefits of the insured person to pay once a year, unified payment in September each year. If the insured person is insured outside September every year, a waiting period of 3 months will be set, that is, the insured person can pay the insurance premium in the fourth month from the month when he is insured, and he will enjoy the medical insurance benefits in the month when he pays the premium. By setting a waiting period of three months, we can prevent the phenomenon of insurance only when you are sick, but not when you are not sick.