With the great attention of the Municipal Party Committee and the Municipal Government, and through the hard work of the labor and security departments at the city and county levels, the pilot project of basic medical insurance for urban residents has achieved good social results.
In order to further improve our city's basic medical insurance policy for urban residents and improve the treatment level of insured residents, combined with the actual situation of our city's basic medical insurance for urban residents, the following adjustments and supplements are made to the "Implementation Rules of Xianyang Basic Medical Insurance for Urban Residents": 1.
The city's basic medical insurance for urban residents is coordinated at the municipal level.
2. Urban residents’ basic medical insurance premiums are collected and paid in a natural year, and the payment period for the next year is from September 1 to December 31 each year.
1. There is a three-month waiting period for medical benefits for urban residents newly insured in 2009; there is a six-month waiting period for medical benefits for urban residents insured after 2009, and they are not allowed to enjoy basic medical insurance benefits during the waiting period.
2. If insured residents fail to pay the new year’s medical insurance premiums on time, they will enjoy basic medical insurance benefits from the month after payment.
3. If the payment of premiums is interrupted for more than one year (including one year) after joining the insurance, there will be a 3-month waiting period for medical insurance benefits starting from the month after the renewal is processed.
3. Lower the minimum payment standard (see the table below for details): Hospital-level minimum payment standard for age groups (yuan) 600 for third-level hospitals over 18 years old 320 for second-level hospitals 180 for first-level hospitals 120 for community medical and health service centers 120 for third-level hospitals under 18 years of age
300 for first-level hospitals, 200 for second-level hospitals, 100 for first-level hospitals, and 60 for community medical and health service centers. 4. Increase the payment ratio of the basic medical insurance coordinating fund.
50% for third-level designated hospitals; 65% for second-level hospitals; 70% for first-level hospitals; and 80% for community medical and health service centers.
5. Expand the payment scope of the basic medical insurance pooling fund.
1. Among the insured residents, the childbirth of women who meet the provisions of national policies will be included in the payment scope of the basic medical insurance co-ordinating fund.
2. Accidental injuries to students and children who are not third-party responsible persons are included in the payment scope of the basic medical insurance co-ordinating fund.
6. Increase the proportion of medical insurance funds paying for disposable blood pipelines used by hemodialysis patients.
When the cost of disposable blood pipelines used by hemodialysis patients is ≤30 yuan, 10% will be borne by designated medical institutions, 30% will be borne by insured residents, and 60% will be borne by the basic medical insurance co-ordinating fund.
Any amount exceeding RMB 30 will be fully borne by designated medical institutions.
7. Increase the number of diseases for single-disease settlement and increase the fund payment ratio.
1. The number of diseases settled under a single category has increased to eleven. The new categories include: thoracic and lumbar fractures (except first-degree compression fractures and simple accessory fractures), humeral shaft fractures, and pelvic fractures (stable according to Tile classification)
Except), femoral shaft fracture.
2. The disease burden ratio for single disease settlement is adjusted to: third-level designated hospitals bear 13%, second-level designated hospitals bear 11%, and first-level designated hospitals bear 9%; the medical insurance fund pays 42% to third-level designated hospitals, and second-level designated hospitals bear 42%.
52% are designated hospitals and 62% are first-level designated hospitals.
8. Increase the types of diseases that are paid according to the type of disease and increase the limit of medical expenses.
1. Newly paid diseases based on disease type: coronary artery bypass grafting, cardiac radiofrequency ablation, and artificial knee replacement.