The Ya'an Urban Resident Basic Medical Insurance System will be officially implemented on June 1 Sichuan Online (2009-05-1510:36:28) Source: Ya'an Daily Recently, the city's Urban Resident Basic Medical Insurance has been launched on TV A telephone conference was held, and the meeting announced the "Interim Measures for the Basic Medical Insurance for Urban Residents of Ya'an City" (hereinafter referred to as the "Interim Measures"), which will be fully implemented from June 1.
Full coverage of the basic medical insurance system
The "Interim Measures" propose that the basic medical insurance for urban residents should be coordinated at the municipal level. The scope of insurance is all urban residents within the administrative region of our city who are not covered by the urban employee basic medical insurance system, specifically including: primary and secondary school students with urban resident registration, non-school children under the age of 18, and children under the age of 18. Non-employed urban residents over 1 year old.
“The goal of establishing a basic medical insurance system for urban residents is to achieve basic medical security for everyone.” It is understood that currently, there are 170,000 urban employees and flexible employment personnel participating in basic medical insurance in our city. The new rural cooperative medical system has covered 1.19 million people. Due to various reasons, there are still about 160,000 urban non-employees, college students, primary and secondary school students, and preschool children who have not yet been included in the basic medical insurance.
It is understood that the basic medical insurance fund for urban residents consists of basic medical insurance premiums paid by insured urban residents, government subsidy funds, and fund interest income.
The "Interim Measures" stipulate that the financing level of basic medical insurance for urban residents is determined based on a certain proportion of the per capita disposable income of urban residents in this city in the previous year. Basic medical insurance premiums for urban residents are composed of individual contributions and government subsidies. In addition to central and provincial government subsidies, municipal and county (district) governments will also provide subsidies at the standard of 10 yuan per person per year. For children who are eligible for subsistence allowances or who are severely disabled, the city and county (district) governments will provide an additional subsidy of 5 yuan per person per year; for other subsistence allowance recipients, severely disabled people who have lost the ability to work, and elderly people over 60 years old from low-income families For each person, the city and county (district) governments will provide an additional subsidy of 50 yuan per person per year. The city and county (district) governments will bear 30% of the subsidy funds, and the county (district) finance will bear 70%. All counties (districts) should incorporate subsidy funds into their fiscal budgets and allocate them in a timely manner. The "Three Nos" people in urban areas who have no ability to work, no source of livelihood, and no legal caregivers (dependants) do not pay personally, and are fully subsidized by local medical assistance funds, and the remaining part is borne by the local finance.
The "Interim Measures" stipulate that those who are within the scope of insurance who participate in insurance and pay premiums in the current year will enjoy medical insurance benefits from the month following the payment; those who are within the scope of insurance who do not participate in insurance and pay premiums in that year will You can enjoy medical insurance benefits 6 months after signing up and paying premiums. If urban residents fail to renew their medical insurance premiums on time after participating in the insurance, they will stop enjoying medical insurance benefits from the time when payment is interrupted. If you continue to pay within one year after interrupting payment, you will enjoy medical insurance benefits from the month following the payment. If you interrupt payment for more than one year and then continue payment, you can only enjoy medical insurance benefits after 6 months of payment.
Establish minimum payment standards and maximum payment limits
The "Interim Measures" stipulate that after urban residents participate in insurance and pay premiums, they can enjoy inpatient medical expenses and outpatient medical expenses for special diseases in accordance with the provisions of these measures. reimbursement benefits. The scope of payment for inpatient medical expenses and outpatient medical expenses for special diseases shall be implemented in accordance with the "Sichuan Province Basic Medical Insurance and Work Injury Insurance Drug Catalog", "Sichuan Province Basic Medical Insurance Diagnosis and Treatment Item Catalog" and "Sichuan Province Basic Medical Insurance Medical Service Facility Project Scope". When there are new national and provincial regulations, the new regulations will be implemented.
Carrying out basic medical insurance for urban residents is another major decision made by the Party Central Committee and the State Council in paying attention to people's livelihood. It is an important policy measure that benefits the majority of urban residents, especially low-income groups.
The comprehensive launch and implementation of the basic medical insurance for urban residents in our city will help fundamentally solve the problem of serious medical expenses for these people, and also marks the realization of full coverage of basic medical insurance in our city .
The "Interim Measures" also stipulates that the urban residents basic medical insurance sets a minimum payment standard and a maximum payment limit. Medical expenses that are above the minimum payment standard and below the maximum payment limit and meet the payment scope shall be covered by the urban residents basic medical insurance. The medical insurance fund and the individual bear proportionally.
The reporter learned that the minimum payment standards are 600 yuan for third-level medical institutions, 450 yuan for second-level medical institutions, 260 yuan for first-level and lower medical institutions, and 150 yuan for community health service institutions run by the government. .
The payment ratio for those above the minimum payment standard and below the maximum payment limit is: 50% for third-level medical institutions, 55% for second-level medical institutions, 60% for first-level and lower medical institutions, and government-run medical institutions. 70% of community health service institutions. For every 5 years of continuous payment of insured persons, the payment ratio will increase by 3 percentage points.
The "Interim Measures" point out that based on the calendar year, the maximum payment limit per person per year is 30,000 yuan. For every five years of continuous payment of insured persons, the payment limit will be increased by 10,000 yuan, with the maximum increase not exceeding 30,000 yuan.
At present, the basic medical insurance for urban residents has been fully launched in our city. By the end of this year, the number of insured people in the city will reach more than 50% of the number of urban residents who should be insured, and by 2010, it will reach more than 80% of the number of urban residents who should be insured.