On February 4th, 65438, the Interim Measures of Basic Medical Insurance for Urban Residents in Xi was fully launched.

■/kloc-children under 0/8 years old (including children of migrant workers who have been studying and living in cities with their parents for a long time) and urban non-employed residents over 0/8 years old can participate in the insurance.

■ Xi residents' medical insurance shall be coordinated at the municipal level, and it is determined that it will be gradually pushed out in six districts, three suburbs and four counties in three stages from now until 2009.

■ Medical expenses for fighting, fighting, alcoholism, drug abuse and other injuries caused by crime or violation of the Law on Public Security Administration Punishment will not be paid.

■ Emergency rescue of patients is not restricted by medical treatment, but they should go through the examination and approval procedures at the district medical insurance agency within 3 working days.

From today, all primary and secondary school students, children and non-employed urban residents in Xi will be able to participate in medical insurance. The insurance will be used to pay the insured's medical expenses such as hospitalization and outpatient serious illness. However, the medical expenses caused by fighting, fighting, alcoholism, suicide, self-harm and other acts are not included in the scope of medical insurance payment. Yesterday, Xi Labor and Social Security Bureau officially launched the Interim Measures for Basic Medical Insurance for Urban Residents in Xi, announcing that the framework of Xi's four major security systems has been formed. It is reported that this policy of benefiting the people will cover the whole city by 2009, and10.8 million residents in Xi will benefit from it when treating diseases.

Children of migrant workers can also be insured.

The insured object and scope of the basic medical insurance for urban residents in Xi City include the following persons who are not included in the basic medical insurance for urban employees within the administrative area of this Municipality: students in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools) and other children under the age of 18 (including children of migrant workers who have been studying and living in the city with their parents for a long time). Non-employed urban residents with local household registration and 18 years of age or older.

Those who meet the insurance conditions can be handled within half a year.

Xi. The basic medical insurance for urban residents takes the family as the unit. Urban residents to the domicile of the community labor and social security workstation for insurance procedures; Students who belong to the collective household registration in cities and towns in this Municipality shall be registered centrally by their schools and go through the insurance formalities at the medical insurance agencies in their districts.

Urban residents who meet the insurance conditions should go through the insurance registration and payment procedures within six months after the implementation of the Interim Measures for the Basic Medical Insurance for Urban Residents in Xi, and then pay insurance premiums in a continuous annual manner (the payment period is from 10 to 15+065438+30). Newborns, land-expropriated farmers who have completed the village withdrawal and moved into Xi, and various new urban residents who meet the insurance conditions can pay insurance premiums immediately.

Xi urban residents need to bring the following materials when registering for insurance: household registration book, ID card and its copy, two recent two-inch bareheaded color photos with the same background (preschool children provide photos of mother and son or father and son with the same background) and valid certificates of other family members participating in medical insurance in the household registration book (subject to the insurance certificate issued by the medical insurance department); Newborns need to provide originals and photocopies of birth certificates and other related materials.

The severely disabled people with urban minimum living allowance also need to provide the originals and photocopies of relevant certification materials such as the Xi Minimum Living Guarantee Certificate for Urban Residents and the China People's Disabled Certificate.

Children of migrant workers who go to school and live with their parents in this city for a long time are required to provide their parents' temporary residence permit, household registration book of origin, proof of going out to work and proof of long-term labor relations.

Children are handed over to 30 yuan every year.

The basic medical insurance fund for urban residents is raised according to the standard of 100 yuan per person per year. Individuals pay 30 yuan and give financial assistance to 70 yuan. Among them, the minimum living allowance for severely disabled children is paid by individuals 10 yuan, and economic subsidies are given to 90 yuan.

Urban non-employed residents are raised according to the standard of 250 yuan per person per year. Individual contribution 180 yuan, giving economic subsidies to 70 yuan. Among them, the minimum living allowance, severe disability and low-income elderly people over the age of 60 pay 20 yuan and financial subsidies to 230 yuan (including 150 yuan Disabled Employment Security Fund).

After the insurance, the payment will be interrupted within 6 months. When going through the renewal procedures, the medical insurance premium during the interruption period should be paid in full (including 50% of the elderly over 60 years old, severely disabled and low-income families), and enjoy the basic medical insurance benefits for urban residents from the next month; If the payment is interrupted for more than 6 months, in addition to paying the medical insurance premium according to the above provisions, you will enjoy the waiting period of 6 months (you will not enjoy the basic medical insurance for urban residents during the interruption of payment and waiting period).

The maximum payment limit for children is 40 thousand yuan

The basic medical insurance for urban residents in Xi mainly guarantees hospitalization and outpatient serious illness medical treatment. The scope of medication, diagnosis and treatment items, service facilities and inpatient diseases of the basic medical insurance for urban residents shall be implemented in accordance with the relevant provisions of the basic medical insurance for urban employees.

Insured residents in the designated medical institutions in line with the provisions of medical insurance settlement and payment of hospitalization (including family beds) medical expenses, the implementation of the determination of Qifubiaozhun, more than Qifubiaozhun part according to the level of hospitalization in proportion to pay and the highest payment limit control approach.

Qifubiaozhun is divided into: 250 yuan, a community service organization; 350 yuan, a first-class hospital; 500 yuan, a secondary hospital; 700 yuan, a tertiary hospital.

The annual cumulative maximum payment limit (total hospitalization and outpatient expenses for serious illness) is: 35,000 yuan for urban non-employed residents and 40,000 yuan for children.

In accordance with the provisions of Qifubiaozhun above, below the maximum payment limit of hospitalization medical expenses, in designated medical institutions at all levels to pay according to the following proportion:

1, urban non-employed residents

Community health service institutions, the overall fund to pay 70%, individuals bear 30%;

A hospital, the overall fund to pay 60%, individuals bear 40%;

Secondary hospitals, the overall fund pays 50%, and individuals bear 50%;

For tertiary hospitals, 40% is paid by the overall fund and 60% is borne by individuals;

2, children's overall fund payment ratio according to the corresponding standard of urban non employed residents increased by 5%.

Medical expenses above the maximum payment limit and beyond the scope of payment are no longer borne by the overall fund, and can be solved by establishing large medical subsidies, commercial health insurance or medical assistance.

Serious outpatient diseases include: special outpatient diseases (radiotherapy and chemotherapy for malignant tumors, outpatient renal dialysis, taking anti-rejection drugs after organ transplantation) and chronic diseases (hypertension, coronary heart disease, diabetes).

Outpatient treatment of special diseases: 50% from the overall fund and 50% from individuals;

Outpatient treatment of chronic diseases: In one year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed 350 yuan, the excess will be paid by the overall fund according to the standard of 50%, and the maximum payment limit of the overall fund is 2,000 yuan.

Medical expenses such as fighting are not covered.

Medical expenses incurred by the insured in non-designated medical institutions without approval; Suicide or self-mutilation (except mental illness); Fighting, fighting, alcoholism, drug abuse and other injuries cause crimes or violate the law on public security administration punishment; Traffic accidents, accidental injuries, medical accidents, etc. ; Because of beauty, plastic surgery, physical defects and other treatments; Belonging to the scope of work-related injury insurance (including occupational diseases) or residual insurance payment; The fund will not pay for other non-payment cases stipulated by the national and provincial medical insurance policies.

The first aid and rescue of patients are unrestricted.

The basic medical insurance for urban residents shall be managed by designated medical institutions (including designated community health service institutions). Insured residents who meet the requirements and need hospitalization can choose the designated medical institutions of basic medical insurance for urban workers in Xi for medical treatment. Emergency and rescue patients are not subject to this restriction, but they should go through the examination and approval procedures at the district medical insurance agency within 3 working days.

Insured residents suffering from diseases diagnosed by outpatient attending doctors that really need hospitalization and conform to the catalogue of hospitalization diseases, patients or their families shall go through hospitalization procedures with patient ID card, Special Medical Records for Basic Medical Insurance for Urban Residents in Xi, hospitalization certificate issued by outpatient doctors and necessary inspection and diagnosis basis.

Settlement method of hospitalization medical expenses of insured residents: the personal burden is accounted for by designated medical institutions.

The basic medical insurance for urban residents shall be settled in hospital. Insured residents in hospital pay a certain proportion of medical expenses in advance (including Qifubiaozhun and individual pays the deposit), and when they leave the hospital (if the first diagnosis after discharge conforms to the catalogue of diseases), they will be charged by the designated medical institutions, and if they are personally burdened, they will be paid in advance by the personal deposit, and more will be refunded and less will be made up; Is part of the overall fund payment, by the designated medical institutions and municipal medical insurance agencies monthly settlement.

Emergency hospitalization expenses incurred by insured residents in different places due to family visits, vacations, etc. are included in the basic medical insurance fund. When submitting reimbursement, you must provide the discharge summary, the first page of medical records, copies of long-term and temporary doctor's orders, details of hospitalization expenses, hospitalization bills, disease diagnosis certificates and hospital level certificates.

Those who have gone through the insurance procedures and paid in full within the prescribed payment period will enjoy the basic medical insurance benefits for urban residents from the following year 1+0; Meet the conditions of the new urban residents, enjoy the basic medical insurance for urban residents from the next month.

For urban residents who meet the insurance conditions and fail to go through the insurance registration and payment procedures within 6 months according to the regulations, in addition to the normal payment, individuals should also pay the medical insurance premium in full from the date of implementation of the Measures to the time of insurance, and part of the financial payment of medical insurance premium will not be subsidized, and the treatment will enjoy a waiting period of 6 months.

According to the relevant person in charge of Xi 'an Labor and Social Security Bureau, on July 23rd this year, Xi 'an was listed as one of the 79 pilot cities in China by the National Conference on the Pilot Work of Basic Medical Insurance for Urban Residents. The promulgation of the Interim Measures for Basic Medical Insurance for Urban Residents in Xi 'an will announce that the four major security system frameworks of Xi 'an have been formed. According to the reporter's interview, Xi residents' medical insurance will be implemented as a whole at the municipal level, and will be gradually carried out in six districts, three suburbs and four counties in three stages from now until 2009. By the end of the year, it will cover 65438+200,000 people. At present, the new city, beilin district, Lianhu District, Yanta District, weiyang district and Baqiao District (including High-tech Zone, Economic Development Zone, Qujiang New District and Chanba Ecological Zone) will be started first, and Chang 'an District, Lintong District and yanliang district will be started gradually before the end of June 2008. Gaoling County, zhouzhi county, Huxian County and Lantian County. After the basic medical insurance for urban residents is fully covered, there will be10.8 million residents in Xi city who will benefit from the treatment of diseases.

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