When will the basic medical insurance for urban residents be paid?

the basic medical insurance for urban residents takes the natural year as the insurance year. Insured residents pay medical insurance premiums according to the natural year, and the payment time is from October 1st to November 3th every year.

in order to facilitate the payment and management of the insured residents, the initial period of the basic medical insurance for urban residents, that is, from October 1, 27 to December 31, 28, is an insurance year, and the insured residents should pay the medical insurance premium in full for 15 months at one time.

answers to the knowledge about participating in the basic medical insurance for urban residents in Honghe prefecture

1. What are the scope and objects of the basic medical insurance for urban residents?

(1) All non-employed urban residents, students and children (including children of migrant workers who go to school with their parents in the city) who are not covered by the basic medical insurance for urban workers and the new rural cooperative medical system within the administrative area of this state can participate in the basic medical insurance for urban residents in the form of units (schools, parks, institutes), families or individuals according to regulations.

(2) Children of migrant workers (who have lived with their parents for more than three years, subject to the registration time of the local police station) who have not participated in the new rural cooperative medical system can participate in the basic medical insurance for urban residents.

(3) All and most rural residents who have lost their land can choose to participate in the basic medical insurance for urban residents with the certificate issued by the villagers' committee. Most rural residents who lost their land refer to rural residents whose per capita area of existing cultivated land is less than .3 mu (including .3 mu) after losing their land.

(4) Other persons who are covered by the basic medical insurance for urban workers and the new rural cooperative medical system will no longer participate in the basic medical insurance for urban residents.

second, how to participate in the basic medical insurance for urban residents?

(1) If the household registration belongs to the county or city where the school (park, institute) is located, the school (park, institute) shall uniformly organize and fill in the Registration Form for the Application of the Basic Medical Insurance for Urban Residents in Honghe Prefecture and the List of the Insured Persons in the Basic Medical Insurance for Urban Residents in Honghe Prefecture, and go through the insurance formalities and issue a notice of payment confirmation after being examined and confirmed by the local medical insurance agency.

(2) If the household registration does not belong to the county or city where the school (park, institute) is located, you should go back to the county or city where the household registration is located with the school certificate and go through the insurance registration procedures according to the following provisions.

(3) Other urban residents? (including minors who are not in schools, parks and institutes) to participate in the basic medical insurance for urban residents, and to fill in the Application Registration Form for Urban Residents' Basic Medical Insurance in Honghe Prefecture at the township and street community labor and social security offices (stations) where the household registration is located, and go through the insurance registration procedures. After the territorial medical insurance agency verifies and confirms its identity, it will issue a notice of payment confirmation.

3. What certification materials should be provided when applying for insurance?

urban residents (including students and children) are required to bring their household registration book, ID card and a recent five-point color photo without a hat when going through the insurance registration procedures. The following personnel also need to provide considerable proof materials when participating in the insurance:

(1) Urban residents' minimum living guarantee card is required for urban residents.

(2) Persons with severe disabilities who have lost their ability to work are required to provide the Disabled Persons' Certificate of the People's Republic of China.

(3) Old people over 6 years old from low-income families need to provide proof that the social security department has not received pension insurance benefits.

4. What is the payment standard of basic medical insurance for urban residents?

(1) Students and children shall be paid at .6% of the average social wage in Quanzhou in the previous year, and the financing standard shall not be lower than that in 1 yuan.

(2) Other non-employed urban residents shall pay 1.3% of the average social wage in Quanzhou in the previous year, and the financing standard shall not be lower than that in 22 yuan.

5. What are the standards for family, individual and government subsidies?

(1) Special groups of adults (urban subsistence allowances, severely disabled people who have lost their ability to work, and elderly people over 6 years old from low-income families): they are fully subsidized by finance, and individuals do not pay fees.

(2) Other residents among adults: financial assistance to 15 yuan and individual contributions to 7 yuan.

(3) Students and children in primary and secondary schools, vocational high schools, technical secondary schools and technical schools: financial assistance to 9 yuan and individual contributions to 1 yuan.

(4) students in primary and secondary schools, vocational high schools, technical secondary schools, technical schools and children with minimum living allowances or severely disabled people: they are fully subsidized by finance, and individuals do not pay fees.

(5) Full-time college students: they used to enjoy full financial subsidies for free medical care, and individuals did not pay fees; Everyone who does not enjoy free medical care pays 1 yuan every year, and the rest is financially subsidized.

VI. When will the basic medical insurance for urban residents be paid?

the basic medical insurance for urban residents takes the natural year as the insurance year. Insured residents pay medical insurance premiums according to the natural year, and the payment time is from October 1st to November 3th every year.

in order to facilitate the payment and management of the insured residents, the beginning of the basic medical insurance for urban residents, that is, from October 1, 27 to December 31, 28, is an insurance year, and the insured residents should pay the medical insurance premium in full for 15 months at one time.

VII. How to collect the individual and family contributions of the basic medical insurance for urban residents?

(1) Students and children who are insured by schools (parks, institutes) shall be collected from the students and children by the schools (parks, institutes) with the insurance payment confirmation notice issued by the local medical insurance agencies within the prescribed payment period, and then paid into the designated bank within 5 working days, and the designated bank shall issue a social insurance payment receipt.

(2) Other insured residents shall be paid in full in one lump sum by individuals or families at the designated bank outlets with the notice of confirmation of payment issued by the medical insurance agency in the counties and cities where they are insured within the prescribed payment period, and the designated bank shall issue a receipt for social insurance premiums.

(3) The villages and towns without designated bank outlets shall be collected by the institutions entrusted by the bank.

8. how to issue the basic medical insurance card and social security card for urban residents?

(1) Schools (parks, institutes) that organize students and children to participate in insurance shall, with the receipt of social insurance premium issued by the designated bank, go to the local medical insurance agency to receive the medical insurance certificate and social security card, and distribute them to the students and children themselves.

(2) Other insured residents will receive medical insurance cards and social security cards from the streets and communities where they are registered with insurance by holding the social insurance fee receipt issued by the designated bank.

(3) The loss reporting and replacement of the medical insurance card and social security card shall be handled by the insured residents or clients at the medical insurance agency in the insured area.

9. Can the insured residents continue to enjoy the relevant benefits if they fail to go through the renewal procedures for the next year and stop paying medical insurance premiums?

insured residents should go through the renewal procedures for the next year before November 3th of that year, and pay the medical insurance premium for the next year. Those who are overdue will no longer enjoy the basic medical insurance payment subsidy for urban residents in the next year. Those who do not go through the renewal procedures according to the year and interrupt payment for more than one year must pay all the medical insurance premiums in the interrupted year in full before they can go through the renewal procedures.

1. Can the insured residents continue to use their personal social security cards and medical insurance cards when their household registration is transferred within the state?

you can continue to use it. However, the insured residents should issue a medical insurance relationship transfer form to the medical insurance agency where the household registration moves out, and then go through the change procedures at the medical insurance agency where the household registration moves in.

Xi. Under what circumstances does the insured terminate the basic medical insurance relationship for urban residents during the insured year?

(1) if the registered permanent residence of the insured residents moves out of the state, the relationship and treatment of basic medical insurance for urban residents will be terminated at the end of this insured year.

(2) If the insured residents die, their families or clients shall go to the medical insurance agency for cancellation and termination of the medical insurance relationship with their death certificates and their social security cards and medical insurance certificates. If the medical expenses have not been settled, they should be handled in time, and then go through the cancellation procedures to terminate the medical insurance relationship.

(3) if it is recruited by state organs, institutions, enterprises and other employers, the basic medical insurance for urban residents will be terminated and transferred to the basic medical insurance for urban employees.

(4) if the insured residents are sentenced to prison for execution, the medical insurance relationship will be terminated automatically, and the paid medical insurance premium will not be refunded.

12. Can people who have participated in the basic medical insurance for urban residents be transferred to the basic medical insurance for urban employees if they have the conditions to participate in the basic medical insurance for urban employees?

urban residents who have the ability to work within the working age should be employed in various ways and participate in the basic medical insurance for urban workers. Residents who have participated in the basic medical insurance for urban residents and have the conditions to participate in the basic medical insurance for urban employees can be transferred to the basic medical insurance for urban employees. The payment period for participating in the basic medical insurance for urban residents will not be paid.

XIII. When did the participating residents begin to enjoy medical treatment?

after the insured residents pay the medical insurance premium in full within the specified time, they will enjoy the medical treatment of serious illness and hospitalization in the basic medical insurance for urban residents from the next month. Do not pay in full or on time or interrupt payment, and stop enjoying the basic medical insurance benefits for urban residents.

XIV. At present, what kinds of serious outpatient diseases are recognized by the basic medical insurance for urban residents? How to reimburse the outpatient expenses?

There are three types: malignant tumor, dialysis of chronic renal failure and anti-rejection after renal transplantation. After applying to the medical insurance agency and being approved, the medical expenses for outpatient treatment can be included in the medical insurance fund to pay according to the provisions of hospitalization.

15. What are the fluctuation standards of hospitalization, the maximum payment limit and the proportion of individual pays for the basic medical insurance for urban residents?

(1) The fluctuation standard of hospitalization is 6 yuan, a designated medical institution outside the state; The first-class designated medical institutions in the state are 5 yuan, the second-class designated medical institutions are 3 yuan, and the third-class designated medical institutions are 1 yuan.

For special groups of insured residents (urban minimum living allowances, severely disabled people who have lost the ability to work, elderly people in low-income families over 6 years old), urban minimum living allowances and severely disabled people among students and children, the hospitalization qifubiaozhun will be halved.

(2) The maximum payment limit of the basic medical insurance fund for urban residents in Honghe Prefecture is 16, yuan per person per year.

(3) The individual pays 5% of the medical expenses that meet the requirements of the basic medical insurance for urban residents above the threshold and below the maximum payment limit; 45% of the first-class designated medical institutions in the state, 35% of the second-class designated medical institutions, and 2% of the third-class designated medical institutions.

16. What is the standard for paying for beds in general hospitals?

12 yuan per person per day in Class I designated medical institutions, 8 yuan per person per day in Class II designated medical institutions and 6 yuan per person per day in Class III designated medical institutions. Other hospital bed fee payment standard is not higher than 3 yuan per person per day. If the actual bed fee is lower than the payment standard, the actual bed fee shall be settled and paid according to the regulations; If it is higher than the payment standard, it shall be settled and paid according to the payment standard, and the excess shall be borne by the individual.

XVII. How to pay for Class A and Class B drugs within the scope of basic medical insurance for urban residents?

(1) The expenses of Class A drugs shall be paid from the basic medical insurance fund for urban residents according to regulations.

(2) The individual pays 1% of the expenses for Class B drugs first, and the remaining 9% is paid from the urban residents' basic medical insurance fund according to regulations.

(3) The expenses incurred by using restricted drugs within the rescue scope shall be borne by the individual at first, and the remaining 8% shall be paid from the basic medical insurance fund for urban residents according to regulations.

XVIII. What are the provisions for the scope of special examination, special treatment, special medical materials and artificial organs, as well as the application, approval procedures and payment ratio?

according to the relevant provisions of the basic medical insurance for urban workers.

XIX. How can the insured residents actively renew their insurance, and how can the payment period be linked to the enjoyment of benefits?

The insured residents can enjoy the treatment of reducing the proportion of individual out-of-pocket payment with the increase of the service life. The reduction of the proportion of out-of-pocket payment is based on the premise of continuous payment, and it will be reduced by 1 percentage point every three years, until it reaches 5 percentage points.

if the payment has been made continuously for more than 3 years (including 3 years) but less than 6 years, the proportion of individual pays will be reduced by 1 percentage point; Continuous payment for 6 years (including 6 years) and less than 9 years, the proportion of individual pays is reduced by 2 percentage points, and continuous payment for 9 years (including 9 years) and less than 12 years, the proportion of individual pays is reduced by 3 percentage points; If the continuous payment is over 12 years (including 12 years) but less than 15 years (including 15 years), the proportion of individual pays will be reduced by 5 percentage points.

if payment is interrupted in the middle, the payment period in advance will no longer be counted as the continuous payment period.

2. Can the medical expenses be reimbursed by the basic medical insurance for urban residents when students and children have accidental injuries?

When students and children suffer accidental injuries caused by irresponsible persons, their hospitalization expenses incurred in designated medical institutions can be included in the payment scope of the basic medical insurance fund for urban residents and paid from the basic medical insurance fund for urban residents by virtue of the hospitalization expenses incurred by designated medical institutions, the diagnosis certificate issued by designated medical institutions and relevant certification materials issued by the school.

21. What are the behaviors that insured residents are not allowed to enjoy the basic medical insurance benefits for urban residents and the expenses that are not paid by the basic medical insurance fund for urban residents?

(1) The insured shall not enjoy the basic medical insurance benefits for urban residents under any of the following circumstances:

1. Failing to see a doctor in a designated medical institution (except emergency), transferring to a hospital without approval and other medical treatment behaviors that do not meet the requirements of the basic medical insurance for urban residents.

2. Suicide, self-mutilation, illegal crime, fighting, alcoholism, drug abuse, etc. are medical treatment behaviors caused by personal misconduct.

3. Carry out cosmetic surgery, health care, and install artificial limbs, dentures and artificial eyes.

(2) The following expenses are not covered by the urban residents' basic medical insurance fund:

1. Drug expenses beyond the provisions of the urban residents' basic medical insurance drug list.

2. medical expenses beyond the provisions of the medical insurance treatment project for 1 billion years for urban residents.

3. Service fees beyond the uniform of basic medical insurance service facilities.

4. Registration fee, outpatient medical record fee, patient care fee, ambulance fee, out-of-hospital consultation fee, medical staff's visit fee and travel fee, out-of-hospital consultation fee, medical staff's visit fee and travel fee, qigong fee, weight loss fee, smoking cessation fee, drug treatment fee, treatment fee for sexually transmitted diseases (except AIDS), etc.

5. Medical expenses incurred in traffic accidents.

6. Medical expenses incurred by medical accidents.

7. Expenses incurred in childbirth and family planning.

8. Expenses for forensic identification and work disability identification.

9. Medical expenses incurred overseas (including Hong Kong, Macao and Taiwan).

1. Medical expenses paid within the scope of other insurance and other compensation responsibilities.

11. Other expenses that are not paid according to regulations.

22. How many designated hospitals can the insured urban residents choose?

the basic medical insurance for urban residents is based on the first consultation and two-way referral system with township (community) health service institutions as the mainstay. Insured residents can choose a township (community) health service institution as their first designated medical institution. Suffering from specialized diseases, you can choose one specialized hospital as your first designated hospital, and fill in the Application Registration Form of Basic Medical Insurance for Urban Residents in Honghe Prefecture.