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

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 10 to 1 to1.

In order to facilitate the payment and management of the insured residents, the initial period of the basic medical insurance for urban residents is 10 from June 2007 to February 3, 2008, and the insured residents should pay the medical insurance premium for 1 5 months in one lump sum.

Questions and Answers about Honghe Prefecture's Participation in Basic Medical Insurance for Urban Residents

1. What is the scope and object of basic medical insurance for urban residents?

(1) Non-employed urban residents, students and children (including children of migrant workers who go to school and live in cities with their parents) who are not included in 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 units (schools, parks, institutes), families or individuals according to regulations.

(two) children of migrant workers, (living with their parents for more than three years, subject to the local police station registration time) did not participate in the new rural cooperative medical care, can participate in the basic medical insurance for urban residents.

(three) all and most of the rural residents whose land has been expropriated 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 arable land area is less than 0.3 mu (including 0.3 mu) after losing their land.

(four) other personnel belonging to the basic medical insurance for urban workers and the new rural cooperative medical insurance will no longer participate in the basic medical insurance for urban residents.

Two, 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 of Basic Medical Insurance for Urban Residents in Honghe Prefecture and the List of Insured Persons in 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.

(two) the household registration is not in the county or city where the school (park, institute) is located, and the school certificate shall be used to go back to the county or city where the household registration is located to handle the insurance registration procedures in accordance with 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, fill in the Registration Form for the Application of Basic Medical Insurance for Urban Residents in Honghe Prefecture at the township and street community labor security offices (stations) where the household registration is located, and go through the registration procedures for insurance. After the territorial medical insurance agency verifies its identity, it will issue a payment confirmation notice.

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 1 recent five-point 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:

(a) urban residents, need to provide the "urban residents minimum living guarantee card".

(two) severely disabled persons who have lost the ability to work, and need to provide the "People's Republic of China (PRC) Disabled Persons' Card".

(three) the elderly over the age of 60 in 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 are paid 0.6% of Quanzhou's average salary in the previous year every year, and the financing standard is not less than 100 yuan.

(2) Other non-employed urban residents pay 65,438+0.3% of the average social wage in Quanzhou last year, and the financing standard is not lower than that in 220 yuan.

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

(1) Adults of special groups (urban minimum living allowances, severely disabled people who have lost their ability to work, and elderly people over 60 years old from low-income families): fully subsidized by the government, and individuals do not pay fees.

(2) Other residents among adults: financial subsidies 150 yuan, and individuals pay 70 yuan.

(3) Students and children in primary and secondary schools, vocational high schools, technical secondary schools and technical schools: financial aid to 90 yuan, individual contribution 10 yuan.

(4) Students and children in primary and secondary schools, vocational high schools, technical secondary schools, technical schools, low-income or severely disabled people: full financial subsidies, 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; Those who do not enjoy free medical care will pay 10 yuan every year, and the rest will be financial subsidies.

6. When will the basic medical insurance for urban residents be issued?

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 10 to 1 to1.

In order to facilitate the payment and management of the insured residents, the initial period of the basic medical insurance for urban residents is 10 from June 2007 to February 3, 2008, and the insured residents should pay the medical insurance premium for 1 5 months in one lump sum.

Seven, the basic medical insurance for urban residents, individual and family contributions how to collect?

(a) schools (parks, institutes) organize students and children to participate in the insurance, and the schools (parks, institutes) shall, within the prescribed payment period, submit the insurance confirmation payment notice issued by the local county and city medical insurance agencies, collect it from students and children in a unified way, and pay it into the designated bank within 5 working days, and the designated bank shall issue a receipt for social insurance payment.

(II) Other insured residents shall pay in full by individuals or families at designated bank outlets within the prescribed payment period with the notice of payment confirmation issued by the medical insurance agency in the county or city where they are located, and the designated bank shall issue a receipt for social insurance premiums.

(three) towns without designated banks shall be collected by institutions entrusted by banks.

Eight, how to issue the basic medical insurance card and social security card for urban residents?

(a) schools (parks, institutes) that organize students and children to participate in insurance shall, with the receipt of social insurance premiums issued by designated banks, go to local medical insurance agencies to receive medical insurance certificates and social security cards, and distribute them to students and children themselves.

(two) other insured residents, with the receipt of social insurance premiums issued by designated banks, go to the streets and communities to register for insurance and receive medical insurance cards and social security cards.

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

Nine, the insured residents did not go through the renewal procedures for the next year in accordance with the regulations, and interrupted the payment of medical insurance premiums. Can they continue to enjoy the relevant treatment?

Insured residents should go through the renewal procedures for the next year and pay the medical insurance premium for the next year before June 30, 2008 +065438. Overdue, next year will no longer enjoy the basic medical insurance payment subsidies for urban residents. If the insurance renewal procedures are not handled according to the year, and the payment is interrupted for more than 1 year, the insurance renewal procedures can only be handled after all the medical insurance premiums in the interrupted year are paid in full.

Ten, the insured residents in the state within the scope of household registration transfer, their personal social security card, medical insurance card can continue to use?

Can continue to use. 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 will the basic medical insurance for urban residents be terminated during the insured year?

(a) the insured household registration from the state to the state, the basic medical insurance benefits for urban residents will be terminated at the end of this year.

(two) the death of insured residents, by their families or clients with death certificates and my social security card, medical insurance card to the medical insurance agencies for cancellation procedures, termination of medical insurance relationship. 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.

(three) by the state organs, institutions, enterprises and other employers to terminate the basic medical insurance for urban residents, into the basic medical insurance for urban workers.

(four) if the insured residents are sentenced to fixed-term imprisonment, the medical insurance relationship will automatically terminate and the paid medical insurance premium will not be refunded.

Twelve, has participated in the basic medical insurance for urban residents, with the conditions to participate in the basic medical insurance for urban workers, can be transferred to the basic medical insurance for urban workers?

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 shall not be paid.

Thirteen, 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 serious illness and hospitalization treatment in the basic medical insurance for urban residents from the next month. If the payment is not paid in full or on time, the basic medical insurance for urban residents will be stopped.

14. What are the major outpatient diseases recognized by the basic medical insurance for urban residents at present? How to reimburse outpatient expenses?

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

Fifteen, the floating standard, the maximum payment limit and the proportion of individual pays for the basic medical insurance for urban residents?

(1) The floating standard of hospitalization is 600 yuan, a designated medical institution outside the state; 500 yuan, a national first-class designated medical institution, 300 yuan, a second-class designated medical institution, and a third-class designated medical institution 100 yuan.

For special groups of insured residents (urban minimum living allowances, severely disabled people who have lost their ability to work, elderly people over 60 years old from low-income families), urban minimum living allowances and severely disabled people among students and children, the hospitalization Qifubiaozhun will be halved.

(two) the maximum payment limit of the basic medical insurance fund for urban residents in Honghe Prefecture is 16000 yuan per person per year.

(3) The individual pays 50% of the medical expenses above the deductible line and below the maximum payment limit of the basic medical insurance for urban residents; 45% of national first-class designated medical institutions, 35% of second-class designated medical institutions and 20% of third-class designated medical institutions.

16. what is the payment standard for beds in general hospitals?

A class of designated medical institutions per person per day 12 yuan, a class of designated medical institutions per person per day in 8 yuan, a class of designated medical institutions per person per day in 6 yuan. Other hospital bed fee payment standard is not higher than 30 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.

Seventeen, urban residents in medical insurance coverage basic class A and B drug costs, how to pay?

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

(two) the cost of class B drugs, the individual pays 10% first, and the remaining 90% is paid from the basic medical insurance fund for urban residents according to regulations.

(three) for the expenses within the scope of rescue and use of restricted drugs, the individual shall pay 20% first, and the remaining 80% shall be paid from the basic medical insurance fund for urban residents.

Eighteen, special inspection, special treatment, special medical materials and artificial organs, as well as the scope of application, approval procedures and payment ratio, according to what provisions?

Comply with the relevant provisions of the basic medical insurance for urban workers.

Nineteen, how to actively renew the insured residents, how to link the payment period with the enjoyment of benefits?

Insured residents enjoy the treatment of reducing the proportion of individual pays. The reduction of the out-of-pocket ratio is based on continuous payment, and it is reduced by 1 percentage point every three years, down to 5 percentage points.

If the continuous payment is over 3 years (including 3 years) but less than 6 years, the proportion of individual contributions will be reduced by 1 percentage point; If the continuous payment is over 6 years (including 6 years) and less than 9 years, the proportion of individual pays will be reduced by 2 percentage points; If the continuous payment is over 9 years (including 9 years) but less than 12 years, the proportion of individual pays will be 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 self-payment will be reduced by 5 percentage points.

If the payment is interrupted midway, the advance payment period will no longer be included in the continuous payment period.

Twenty, students and children have accidental injuries, medical expenses can be reimbursed by the basic medical insurance for urban residents?

Students and children have no responsibility for accidental injuries, and the hospitalization expenses incurred in designated medical institutions can be included in the scope of payment of the basic medical insurance fund for urban residents by virtue of the diagnosis certificate of designated medical institutions and the relevant certification materials issued by the school.

Twenty-one, insured residents are not allowed to enjoy the basic medical insurance for urban residents. What are the expenses that are not paid by the basic medical insurance fund for urban residents?

(a) the insured in any of the following circumstances, do not enjoy the basic medical insurance for urban residents:

1. Failing to go to designated medical institutions for medical treatment (except emergency), transferring to other hospitals without approval and other medical treatment behaviors that do not meet the requirements of basic medical insurance for urban residents.

2. Suicide, self-mutilation, illegal crime, fighting, alcoholism, drug abuse, etc. Is medical behavior caused by personal misconduct?

3, the implementation of cosmetic surgery, medical care, the installation of artificial limbs, dentures, artificial eyes and other medical behavior.

(two) the following expenses do not belong to the basic medical insurance fund for urban residents:

1, the cost of drugs beyond the provisions of the basic medical insurance drug list for urban residents.

2, beyond the provisions of the medical insurance for urban residents, medical expenses for billions of years.

3, beyond the unified service scope of the basic medical insurance service facilities.

4. Registration fee, outpatient medical record fee, hospitalization nursing fee, ambulance fee, out-of-hospital consultation fee, out-of-hospital medical staff visit fee and travel expenses, qigong fee, weight loss fee, smoking cessation fee, drug treatment fee and STD treatment fee (except AIDS).

5. Medical expenses incurred in traffic accidents.

6, medical expenses due to medical accidents.

7, birth and implementation of family planning costs.

8, forensic identification, labor disability identification costs.

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

10, medical expenses paid within the scope of other insurance and other liability.

1 1, and other expenses not paid according to regulations.

Twenty-two, insured urban residents can choose several designated hospitals for the first time?

The basic medical insurance for urban residents is based on the first consultation and two-way referral system of township (community) health service institutions. Insured residents can choose a township (community) health service institution as the first designated medical institution. Suffering from specialized diseases, you can choose 1 specialized hospital as the designated hospital for my first visit, and fill in the Application Registration Form for Basic Medical Insurance for Urban Residents in Honghe Prefecture.

Twenty-three, the insured residents need to be transferred due to major diseases and medical conditions, what are the provisions?

Insured residents should seek medical treatment in designated medical institutions and local hospitals in principle. If it is really necessary to be transferred due to critical illness and medical conditions, it shall be implemented in accordance with the provisions of step-by-step referral. Referral, referral first by the designated medical institutions in charge of doctors put forward referral opinions, with the consent of the director, to the county medical insurance agencies for examination and approval procedures, approval before referral. The referral examination and approval opinions are valid within three days, and the referral examination and approval opinions are valid within seven days. If it is too late to go through the referral and transfer procedures due to critical illness, the procedures should be completed within seven days of referral and transfer, otherwise the medical expenses will not be reimbursed.

Twenty-four What should I do if the insured residents are hospitalized in emergency in different places?

Insured residents who are hospitalized in different places due to emergency should report to the medical insurance agencies in the counties and cities where they are insured within three days of hospitalization, and the related hospitalization expenses can be reimbursed only after approval and filing.

Twenty-five, insured residents need hospitalization, what documents must be brought to go through the admission formalities?

Insured residents need to be hospitalized due to illness, and they must hold personal social security cards and medical insurance cards for admission procedures.

Twenty-six, insured residents in designated medical institutions insured medical expenses, according to what procedures?

(1) Designated hospitals first calculate the total hospitalization expenses according to the price charging standard of non-profit medical services in Yunnan Province and the payment standard of basic medical insurance for urban residents;

(two) according to the provisions of the basic medical insurance for urban residents, calculate all the medical expenses paid by individuals;

(three) after the signature of the insured residents or their families, the self-funded part shall be paid by the individual, and the rest shall be settled by the designated medical institutions and medical insurance agencies.

Twenty-seven, referral, transfer or medical treatment in different places how to settle the medical expenses?

(a) referral, transfer or medical treatment in different places, the medical expenses paid by individuals, after discharge by the insured residents themselves or their clients to the local medical insurance agencies for review and reimbursement.

(2) Effective documents such as referral, transfer approval form, medical insurance card, social security card, discharge certificate, invoice for charges, detailed list of hospitalization expenses, etc. Should be reimbursed.

(three) the time limit for reimbursement of medical expenses for referral, transfer or medical treatment in different places is 30 days after discharge, and those who exceed 30 days will not be reimbursed. Except for delays caused by special reasons such as incomplete reimbursement materials and external disasters.