All state organs, organizations, institutions, enterprises owned by the whole people and enterprises owned by collectives at the county level who participate in social insurance enjoy medical insurance benefits (the medical expenses of the families of retired workers are not included in the overall plan and will not be reimbursed).
Policy:
Article 27 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "Individuals who participate in the basic medical insurance for employees do not pay the basic medical insurance premium after retirement, and if the accumulated payment reaches the number of years stipulated by the state when they reach the statutory retirement age, they will enjoy the basic medical insurance benefits in accordance with state regulations; If it is not reached, it can be paid to the prescribed time limit. " The core spirit of this provision is: "Employees will no longer pay the basic medical insurance premium after retirement,
Enjoy basic medical insurance benefits in accordance with state regulations; The flexible prerequisite of this clause is that "the accumulated payment has reached the fixed number of years stipulated by the state". It is precisely because the country has no unified regulations that all localities have their own needs and do their own things, which infringes on the legitimate rights and interests of laid-off workers and retired workers in social vulnerable groups.
It is not easy to solve the medical insurance problem of laid-off workers and retired workers according to law. The following measures are recommended:
1. It is suggested that the National People's Congress instruct the Supreme People's Court to promulgate and implement the relevant judicial interpretation of the Social Insurance Law of People's Republic of China (PRC) as soon as possible, clearly stipulate the payment period of medical insurance for laid-off workers and retired workers (including deemed payment period of 20 years), and safeguard the legitimate rights and interests of medical insurance for laid-off workers and retired workers in the form of legal system.
Second, it is suggested that the State Council instruct Ministry of Human Resources and Social Security to formulate and implement the implementation opinions of the Social Insurance Law of People's Republic of China (PRC) as soon as possible, clearly stipulating that "if the accumulated contributions of employees after retirement reach 20 years (including the deemed payment period), they will not pay the basic medical insurance premium and enjoy the basic medical insurance benefits in accordance with state regulations."
Third, it is suggested that the State Council instruct the Fujian Provincial Government to cancel the provision in the Detailed Rules for the Implementation of Basic Medical Insurance for Flexible Employees in Fujian Province, which is formulated by the Provincial Department of Labor and Social Security, that the actual payment period of laid-off and retired personnel is 10 year except the payment period (including deemed payment period) is 25 years, and correct their wrong practices and treat laid-off and retired personnel fairly.
The laid-off workers of our state-owned enterprises have made contributions to the country when they are on the job and to the reform when they are laid off. Now that we are retired, how can we be asked to make sacrifices? ! I hope the country will turn the "happiness index" of our laid-off state-owned enterprise retired workers from ideal to reality as soon as possible!
The overall management committee of the retirement pension fund has a medical management office. Before the establishment of the institution, the social insurance company temporarily fails to perform its duties; All townships, towns and fields should set up a trinity medical insurance management team of party committees and governments, medical units and medical insurance institutions. Responsible for the management, service, supervision, approval and coordination of medical expenses, and ensure the rational use of medical insurance expenses.
Treatment:
Medical units and medical staff of medical insurance for retired workers should adhere to civilized medical practice, correct medical ethics, assist medical insurance units to actively do a good job in medical management and service for retired workers, so as to prescribe the right medicine and use drugs rationally.
Basic medical insurance benefits for employees and retirees in urban units (including individual owners and employees, freelancers and migrant workers with household registration in this city).
All urban employers, including enterprises, institutions, social organizations, private non-enterprise units and individual economic organizations, should handle medical insurance for migrant workers who have formed labor relations with them according to regulations.
Urban workers and retirees: all employers in cities and towns, including enterprises (state-owned enterprises, collective enterprises, joint-stock enterprises, foreign-invested enterprises and private enterprises), organs, institutions, social organizations, private non-enterprise units and their employees;
If the insured person is sick, he should go to the outpatient clinic for treatment first. Medical expenses incurred in outpatient treatment in local designated hospitals are directly settled by medical insurance and IC cards in designated hospitals, and the insufficient part is paid by individuals in cash. Medical expenses incurred in non-designated hospitals or outpatient treatment in different places shall be paid in advance by the insured. The outpatient medical expenses and drug purchase expenses of the insured, whether incurred locally or in other places, are not included in the payment scope of the overall fund. Outpatient treatment is ineffective, or serious illness requires direct hospitalization, and hospitalization registration procedures should be handled in time.
Hospital registration should provide the following information:
1, hospitalization certificate issued by outpatient (emergency) doctor and relevant inspection report;
2. The medical insurance certificate and IC card of the insured;
3, the certificate issued by the insured unit.
For critically ill patients who need emergency rescue, regardless of whether they are designated or not, they should follow the principle of first rescue and then treatment, and go through the admission registration formalities at the service hall of the agency with relevant information within 3 days. Insured employees who are hospitalized in local designated hospitals shall submit personal medical insurance and IC cards to the medical insurance department of the hospital for identity check and accounting. If the medical expenses of card-holding inpatients are less than 38,000 yuan, they will be paid in advance by the hospital (the individual pays part), and those above 38,000 yuan will be paid in advance by the insured, and will be paid by the serious illness fund according to the prescribed proportion after discharge. Urban workers and retirees: retirees resettled in different places and on-the-job workers on business trips or vacations who need to be hospitalized due to illness should choose local designated hospitals, and contact the unit in time to register at the service hall of the agency.
Migrant workers to participate in the basic medical insurance, Qifubiaozhun, overall fund payment ratio and maximum payment limit, in accordance with the basic medical insurance standards for urban workers in our city. Migrant workers who need hospitalization can choose medical institutions for hospitalization within the designated medical institutions of the basic medical insurance for urban workers in our city. Voluntary requests to return to their places of origin for treatment, with the consent of the medical insurance agencies, can seek medical treatment in the local designated medical institutions of basic medical insurance for urban workers, and the regional medical insurance agencies should provide medical settlement services in a timely manner.
Article 27 of the recently promulgated "People's Republic of China (PRC) Social Insurance Law" stipulates: "Individuals who participate in the basic medical insurance for employees, when reaching the statutory retirement age, will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; If it is not reached, it can be paid to the prescribed time limit. " The core spirit of this regulation is: "After retirement, employees will no longer pay basic medical insurance premiums and enjoy basic medical insurance benefits in accordance with state regulations; The flexible prerequisite of this clause is: "the accumulated payment has reached the fixed number of years stipulated by the state". It is precisely because the country has no unified regulations that all localities have their own needs and do their own things, which infringes on the legitimate rights and interests of laid-off workers and retired workers in social vulnerable groups.
Hospitalization procedure
1, all retired employees who enjoy social medical insurance shall seek medical treatment in the outpatient department of the hospital stipulated by the medical insurance institution. If the doctor diagnosed the need for hospitalization, he must hold the medical certificate, inspection report, medical record and hospitalization notice issued by the doctor and go to the local medical insurance institution for inspection before being hospitalized.
2, emergency inpatients, can be admitted to the hospital for rescue treatment, within 3 days with emergency certificate for admission examination and approval procedures, otherwise the hospitalization expenses will not be reimbursed.
3, due to serious illness, the local hospital can not be treated, it is really necessary to transfer to a hospital at or above the county level for treatment. The resident will issue a transfer certificate, which will be examined and approved by the local medical insurance institution after being signed by the hospital president. (emergency patients can be transferred to hospital for treatment first, but they must go through the transfer examination and approval procedures within 5 days. ) Medical and drug expenses that are not approved and handled without authorization will not be reimbursed.
Reimbursement ratio
1, retired cadres, retired workers, disabled persons on duty, patients with tertiary silicosis, and secondary disabled soldiers who were hospitalized due to illness before the founding of the People's Republic of China, their medical and drug expenses were reimbursed 100%.
2, retired workers working for more than 30 years, the medical expenses reimbursement of 90%.
3. Retired employees with working experience of 2 1 to less than 30 years will be reimbursed 85% of medical expenses.
4. For retired employees with the length of service 15 to 2 1 year and below, 80% of medical expenses will be reimbursed.
5. Retired employees with less than 15 years of service will be reimbursed 75% of medical expenses.
6, retired workers, medical expenses reimbursement 75%.
7.60% of the hospital bed fee will be reimbursed, and the hospital bed fee will be charged by the company regardless of any hospitalization method.
Medical expenses settlement
1. Before the patient is admitted to the hospital, the medical insurance institution shall pay the hospitalization expenses according to the admission procedure, and the maximum advance shall not exceed 300 yuan. If the advance payment for continuing hospitalization is insufficient, the medical unit shall issue a dunning notice to inform the medical insurance institution to pay one day in advance, and collect the self-funded part of the previous advance payment when paying the advance payment again. Otherwise, the insurance institution refuses to bear the cost of continuing hospitalization.
2. When the patient is discharged from hospital, the medical unit and I shall notify the medical insurance institution one day before discharge, and settle the discharge medical expenses according to the provisions of the three parties. If the medical expenses discharged from the hospital are not settled on time, the medical expenses of this hospitalization will not be reimbursed, and the expenses will be deducted from the retirement fee.
3. When the patient is discharged from the hospital, if he needs to continue taking medicine due to illness, the dosage of chronic diseases should not exceed 7 to 9 days and acute diseases should not exceed 3 to 5 days according to the regulations, otherwise, it should be handled at his own expense.