1 what is the basic medical insurance for urban residents?

The basic medical insurance for urban residents refers to the medical security system that implements the guidance of government organizations, urban residents voluntarily participate, individuals and families pay mainly, and the government gives appropriate subsidies to raise funds for participation, so as to realize medical mutual assistance and mutual assistance through co-ordination of serious illness and appropriate compensation for outpatient expenses.

2 Which residents can participate in urban basic medical insurance?

Non-employees who have non-agricultural population and are not included in the employee medical insurance system within the administrative area of this Municipality may voluntarily participate in residents' medical insurance. Specifically, it includes: primary and secondary school students (including vocational high school students and technical school students), non-school residents aged 65, 438+08 and below: residents aged 60 and above, and women aged 50 and above; Disabled people who have not participated in employee medical insurance and hold disability certificates, and those who have no units and receive the minimum living allowance within the employment age.

3 how to apply for insurance registration and payment?

(1) Starting from 165438+ 10/2, the procedures for residents' medical insurance in 2009 will be handled. At the same time, residents can enjoy hospitalization medical insurance benefits for the rest of 2008 after 30 days from the date of payment.

(2) Primary and secondary school students and preschool children in kindergartens shall go to their schools and kindergartens for registration and insurance payment with their household registration books and two 1 inch color bareheaded photos.

(3) Non-school residents shall go to their neighborhood committees for insurance registration and payment procedures with their household registration book and two 1 inch color bareheaded photos.

(4) The non-agricultural population living in villages and towns shall register for insurance at the local township labor security office with their household registration book and 2 bareheaded photos of themselves 1 inch.

What are the provisions of the basic medical insurance payment standard for urban residents?

Residents' individual payment standards are as follows:

Personal Payment by Personnel (RMB)

/kloc-primary and secondary school students and non-school residents aged 0/8 and below

18 to 50-year-old women and 60-year-old men 150

Women over 50 and men over 60 120

Low-income people over 60 years old

Severely disabled people and low-income individuals do not pay.

How much can insured residents be reimbursed for hospitalization?

Since June 5438+1 October1day, 2009, insured residents have been hospitalized due to illness, and different minimum payment standards, reimbursement rates and maximum payment limits have been implemented according to the level of medical institutions. See attached table:

Medical institutions Qifubiaozhun (yuan) reimbursement ratio maximum payment limit (yuan)

Level 1 medical institutions 200 75% 30,000

Secondary medical institutions 400 65% 30,000

Tertiary medical institutions 900 50% 30000

6 What expenses does the residents' basic medical fund pay?

Residents' basic medical insurance fund is used to pay expenses other than hospitalization, outpatient emergency rescue, diseases listed in Gaocheng urban residents' medical insurance catalogue, outpatient radiotherapy for malignant tumors (including leukemia), outpatient dialysis for chronic renal insufficiency, phacoemulsification and intraocular lens implantation in cataract clinic, and outpatient use of anti-rejection drugs after organ transplantation.

7. How to reimburse the outpatient medical expenses for special diseases?

Insured residents who suffer from malignant tumor (including leukemia) outpatient radiotherapy, chronic renal insufficiency outpatient dialysis, cataract outpatient phacoemulsification and intraocular lens implantation, and use anti-rejection drugs in outpatient clinic after organ transplantation apply, and they are identified and confirmed by the attending physicians of medical institutions above the second level, and issue relevant certificates, and reported to the Medical Insurance Department of the Social Security Bureau for the record. The reimbursement of medical expenses shall be subject to the standards of designated medical institutions.

8. The designated medical institutions for residents to see a doctor are tentatively set as follows:

First-class medical institution: Lianzhou Hospital of Gaocheng City.

Secondary medical institutions: Gaocheng People's Hospital, Gaocheng Hospital of Integrated Traditional Chinese and Western Medicine, and Shijiazhuang Fifth Hospital.

Tertiary medical institutions: Fourth Hospital of Hebei Medical University, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei Provincial Chest Hospital and Hebei Provincial Children's Hospital.

9 how to reimburse insured residents for hospitalization in Gaocheng city?

Residents who are hospitalized in medical institutions of designated hospitals at all levels in Gaocheng City should pay medical expenses first, and report to the hospital immediately when they go through the discharge formalities in the inpatient department with medical guarantee, ID card or household registration book when they leave the hospital.

How to reimburse for hospitalization 10 in medical institutions outside Gaocheng city?

With the approval of the Social Security Bureau, the insured residents should report the approval form, diagnosis certificate, discharge record, receipt of hospitalization expenses and detailed summary of hospitalization expenses to the Medical Insurance Department of the Social Security Bureau through their neighborhood committees within 7 days of discharge.

1 1 which items are not covered by the medical insurance reimbursement for urban residents?

(a) drugs that are seriously inconsistent with my main diseases;

(2) The list of hospitalized drugs is incomplete;

(3) Medical expenses incurred in childbirth;

(four) injuries caused by traffic accidents, medical accidents, cat and dog bites and other accidents;

(5) Being injured because of his violation of the law;

(6) Food poisoning caused by accidents;

(7) Injuries caused by suicide (except mental illness);

(eight) injuries caused by fighting and drinking;

(9) plastic surgery;

(ten) medical expenses incurred during going abroad (Hong Kong, Macao and Taiwan);

(eleven) other medical expenses that do not meet the scope of payment of medical insurance for urban residents.

12 The following cases will not be reimbursed during hospitalization.

(1) Expenses incurred in non-designated medical institutions;

(two) medical expenses incurred during the interruption of the insured residents;

(3) Infusion during the day and rest at home at night;

(four) patients who need blood transfusion during hospitalization operation shall be signed by the attending doctor and the handling nurse and stamped with the special seal for medical treatment before being reimbursed for blood expenses. Non-surgical blood transfusion, blood expenses are self-care;

(5) Unknown expenses such as travel expenses, accommodation fees, registration fees, expert consultation fees, quality service fees, overtime fees, electrical appliances fees, meals, nutrition fees, nursing fees, special care fees, barbecue fees, insurance fees, cooling fees, ward TV fees, refrigerator fees, bedding fees, etc. will not be reimbursed;

(six) after consultation by a doctor, should be discharged from the hospital and refused to leave the hospital. From the day when the doctor mobilized him to leave the hospital, the hospitalization expenses were borne by the individual;

(seven) without approval, the insured residents go to other medical institutions that do not meet the requirements;

(eight) the expenses incurred in transferring to other places for medical treatment without approval;

(nine) medical insurance for urban residents, drugs and medical services.

Tel: 88049255

Gaocheng social security bureau