Three. Funding standard
The financing standard for college students to participate in residents' medical insurance is implemented with reference to the financing standard for students and children to participate in residents' medical insurance in this city, which is shared by individuals and the government. From September/KOOC-0/day, 2009 to August 3/KOOC-0/day, 2065, the fund-raising standard was 220 yuan/person, in which the government subsidized/KOOC-0/20 yuan and the individual paid/KOOC-0/00 yuan. In the future, according to the city's economic and social development level, financial situation, fund operation and changes in medical consumption level, the standards of financing and government subsidies will be adjusted in a timely manner. (1) Personal contribution of college students. In principle, it shall be borne by the college students themselves and their families, and colleges and universities with conditions may give appropriate subsidies for their payment.
(2) government subsidy funds. According to the subordinate relationship, public colleges and universities are arranged by the finance at the same level, that is, students directly under the central government are subsidized by the central government, students from provincial public colleges, private colleges and independent colleges are subsidized by the provincial government, and students from municipal colleges and universities are subsidized by the municipal government.
(3) The individual contributions of college students who enjoy the minimum living guarantee shall be handled by the central finance for universities directly under the central government, and the other universities shall be arranged by the finance at the same level according to their affiliation. College students who enjoy the minimum living guarantee shall be examined and confirmed by their universities with the copy of the minimum living guarantee issued by the civil affairs department of the region (county) where they are registered.
(four) the daily medical subsidy funds for college students. For the funds needed for the daily medical care of provincial public college students who originally enjoyed free medical care, the provincial finance will arrange subsidy funds according to the number of college students who actually participated in residents' medical insurance in that year, and they will still be allocated from the original channels. Universities directly under the central government and municipal universities shall be implemented in accordance with relevant regulations.
(five) the medical expenses of college students with financial difficulties in families shall be borne by individuals according to the regulations, and the medical assistance system, the financial assistance system for students with financial difficulties in families and social charitable donations shall be used to give financial assistance, so as to effectively reduce the burden of medical expenses. As the handling unit for college students to participate in residents' medical insurance, colleges and universities organize the registration and payment of college students' insurance at the beginning of the new school year every year.
(1) declaration and registration. College students who meet the conditions of insurance should fill in the form and provide information as required. Colleges and universities should complete the collection, qualification examination and registration of college students' personal information before 10+05 every year, and go through the insurance formalities at the municipal medical insurance agency for college students.
(2) payment time. College students participate in residents' medical insurance and pay an annual fee. Payment time is from September 1 day to1October 25th1day.
(three) the individual contributions of college students are collected and remitted by colleges and universities. Did not apply for college students' insurance procedures, the medical expenses incurred by college students shall be borne by colleges and universities in accordance with the level of insurance benefits stipulated in this opinion.
(4) Update management. College students who participate in residents' medical insurance should go through the renewal registration formalities according to the regulations every year. College students who are not insured within the prescribed time limit or interrupt the follow-up insurance should go through the formalities of insurance or renewal in the next year's payment period, and can continue to enjoy the residents' medical insurance benefits after a waiting period of 6 months from the next month of payment; The residents' medical insurance fund will not pay the medical expenses incurred during the interruption of payment and the 6-month waiting period.
(5) After every year1October 25th 10, college students should go to the medical insurance agency of college students in the city to handle the insurance formalities for them.
The medical insurance premium paid by college students who transfer, drop out of school or terminate their school status will not be refunded. College students participate in residents' medical insurance, and the guarantee period is one academic year, from September 1 to August 3 1 of the following year. The scope of protection and treatment shall be implemented in accordance with the treatment of students and children who are not less than the medical insurance for residents in this Municipality. Details are as follows:
(a) the scope of protection includes hospitalization, outpatient serious illness, outpatient service, prenatal examination and maternity medical expenses.
(2) The catalogue of medication and medical services shall be implemented with reference to the catalogue of residents' medical insurance.
(3) The serious outpatient diseases are malignant tumor, hemodialysis (including peritoneal dialysis) treatment of severe uremia, anti-rejection treatment after organ transplantation, hemophilia, aplastic anemia, systemic lupus erythematosus and psychosis.
(4) Medical expenses incurred by college students due to personal accidents.
(5) The minimum threshold and the maximum payment limit shall be set for the hospitalization, outpatient serious illness, outpatient service and maternity medical expenses incurred by the insured college students during a guarantee period, and the part above the minimum threshold and below the maximum payment limit shall be paid in proportion.
1, hospitalized. Qifubiaozhun is 500 yuan, a tertiary medical institution, 400 yuan, a secondary medical institution, and 300 yuan, a first-class and below medical institution. If the insured college students are hospitalized several times in a settlement year, the minimum threshold will be gradually reduced, and the second and above hospitalization will be calculated according to 50% of the specified minimum threshold, but the minimum threshold will not be lower than 150 yuan. For the expenses above Qifubiaozhun and below the maximum payment limit, if they are treated in tertiary, secondary, primary and below medical institutions, the proportion of fund payment is 80%, 85% and 90% respectively.
2, outpatient treatment of serious illness. There is no qifubiaozhun, and the medical expenses fund pays 75%.
3. Outpatient treatment. There is no minimum threshold. The fund will pay 40% of the expenses between 0 and 300 yuan, and the expenses above 300 yuan will be borne by individuals.
4, will conform to the national family planning policy of prenatal examination and maternity expenses into the scope of fund payment. The maximum payment amount of the prenatal examination fee fund is 300 yuan. Maternity expenses are paid according to hospitalization expenses.
5. Personal accident injury expenses shall be paid according to the proportion of hospitalization pooling fund, and there is no Qifubiaozhun.
For medical expenses incurred in an insurance period, the accumulative maximum payment limit of the fund is 6,543,800 yuan+500,000 yuan. Every year of continuous payment, the maximum payment limit of the fund will increase by 6.5438+0.00 million yuan, with a maximum of 220,000 yuan.
(6) Colleges and universities continue to do a good job in the daily medical work of college students in accordance with the existing regulations, so as to facilitate college students to seek medical treatment in time. The specific measures shall be studied and formulated by colleges and universities themselves, and shall be implemented after being reported to the municipal labor and social security administrative department for the record on June 65438+1October 3 1 every year. (a) the designated medical institutions for college students shall be implemented in accordance with the relevant provisions of the designated medical institutions for residents' medical insurance. Medical institutions in colleges and universities may apply to the municipal labor and social security administrative department for designated qualifications, and those who meet the conditions may be included in the designated scope.
(two) the municipal labor and social security department made a "Nanjing citizen card" for each insured college student, and the insured college students should hold the card to the designated medical institutions for medical treatment. Business card printing costs are borne by college students themselves.
(3) After college students are insured, the first-visit referral system will be implemented, with designated medical institutions in colleges and universities or community health service institutions as the main ones. Need referral, the first medical institution is responsible for referral. Rescue is not limited to this.
(IV) Insured college students suffering from serious outpatient illness can enjoy the treatment of serious outpatient illness only by virtue of the diagnosis certificate issued by the third-level designated medical institutions or specialized hospitals in this Municipality and the application form for serious outpatient illness signed by the hospital and approved by the chief physician, and reported to the municipal medical insurance agency for the record. Insured college students can choose a medical institution with outpatient serious illness qualification as their designated medical institution for outpatient serious illness.
Insured college students need to bring "Nanjing Citizen Card" and "Outpatient Serious Illness Certificate" to the designated medical institutions for treatment. The insured college students who hold the Certificate of Outpatient Serious Illness are exempted from Qifubiaozhun for hospitalization.
(five) the medical expenses incurred by the insured college students due to personal injury shall be reported to the municipal college students' medical insurance agency for review and reimbursement within 180 days after the personal injury.
(6) During the internship in different places and during the winter and summer vacations, college students can seek medical treatment locally because of emergency hospitalization, and the hospitalization expenses incurred shall be paid in advance by individuals. After discharge, Nanjing citizen card, copy of medical records, hospitalization receipt, expense details, discharge summary and other materials will be handed over to colleges and universities, which will report to the municipal medical insurance agency for review and reimbursement according to regulations. (a) medical expenses incurred by insured college students in designated medical institutions, such as hospitalization, outpatient illness, outpatient service, prenatal examination, reproductive health care, etc., are paid by individuals and settled directly with designated medical institutions by themselves. Belonging to the scope of fund payment, it shall be settled by the municipal college student medical insurance agency and the designated medical institution.
(2) The municipal medical insurance agency for college students and the designated medical institutions shall adopt the method of total amount control, and the settlement control index, quota and lump sum shall be combined for settlement.
(3) The medical insurance agency for college students paid 98% of the medical expenses that met the requirements of designated medical institutions last month, and the remaining 2% was paid according to the annual assessment.
(four) the following medical expenses, the fund will not pay:
1, expenses incurred in non-designated medical institutions;
2. Pay the expenses incurred during the interruption;
3, without the designated hospital for referral costs;
4, without the approval and filing of foreign medical expenses;
5. Drugs and medical services outside the residents' medical insurance catalogue;
6, family planning surgery costs;
7. Injuries caused by the insured college students' own violations of laws and regulations;
8. Suicide and self-mutilation;
9. During going abroad or leaving the country;
10, plastic and cosmetic surgery;
1 1, traffic accidents, medical accidents, drug accidents, etc. The third party is responsible;
12, other payment scope that does not meet the requirements of residents' medical insurance. (a) the funds raised by college students to participate in residents' medical insurance are included in the basic medical insurance fund for urban residents and managed in a unified way.
(two) part of the funds paid by college students are directly included in the financial accounts by the municipal labor and social security department. Government subsidy funds should be fully pre-allocated and settled in the following year. The specific disbursement procedures and measures shall be implemented in accordance with the relevant provisions of the Administrative Measures for the Allocation of Financial Subsidies for College Students in Jiangsu Province to Participate in the Basic Medical Insurance for Urban Residents (No.34 [2009] of Su People's Society). (a) the insured college students who are in school or drop out of school due to illness can continue to enjoy the current medical insurance benefits until the end of the protection period.
(two) the next month after graduation, the insured college students participate in the basic medical insurance for urban workers in this city as flexible employees, without a waiting period of 6 months; Those who meet the requirements of participating in residents' medical insurance and are still willing to participate in residents' medical insurance can continue to participate in residents' medical insurance like other residents. (A) colleges and universities should be clearly in charge of the leadership of medical security management for college students, designate specific management departments, and establish a coordinated management mechanism for relevant departments.
(2) Colleges and universities should organize college students to participate in residents' medical insurance in accordance with the principle of territorial management, earnestly do a good job in the collection and payment of individual contributions of college students, and pay insurance premiums in full and on time.
(3) Colleges and universities should improve the medical conditions of medical institutions in colleges and universities. For colleges and universities that have not established medical institutions or medical institutions are temporarily not qualified, they should choose the nearest designated community health service institutions to ensure the daily medical care of their students.
(3) Colleges and universities should encourage college students to participate in residents' medical insurance on a voluntary basis by participating in commercial medical insurance and other ways to improve the level of medical security.
(four) colleges and universities should cooperate with relevant departments to do a good job in policy propaganda, medical management and difficult subsidies. All relevant government departments should attach great importance to college students' insurance, clarify the division of responsibilities, and actively cooperate to ensure that college students' insurance work is done well.
The labor and social security department is the administrative department in charge of the basic medical insurance for urban residents, and is specifically responsible for the formulation, organization and coordination of college students' insurance policies. The affiliated institutions are responsible for the collection of college students' insurance funds, medical management, payment of benefits and card production, and cooperate with colleges and universities to do a good job in college students' insurance.
The financial departments at all levels are responsible for the supervision and management of the basic medical insurance fund for urban residents, including college students, to ensure that the government subsidy funds needed for college students' insurance are in place in time and in full.
The education department is responsible for urging the municipal colleges and universities to set up a special work leading group, clarifying the institutions and staff of college students participating in insurance, doing a good job in college students' insurance payment and difficult subsidies, and incorporating them into the administrative assessment objectives. Assist in the organization, publicity and guidance of college students' insurance.
Health departments should strengthen the supervision and management of medical institutions, improve the quality of medical services, and urge medical institutions to provide high-quality, cheap, convenient and standardized medical services for college students.
Civil affairs departments should cooperate with labor and social security, education departments and universities to do a good job in the identification of students from low-income families and other related work.