Payment of medical insurance for employees in Hohhot

Hello! Supplementary insurance for serious illness of urban residents in Hohhot will be implemented from 20 15 to 10/,and the average actual reimbursement ratio of supplementary insurance for serious illness will not be less than 50% by 20 1 5. A supplementary insurance system for urban residents with reasonable financing mechanism, sound management system and standardized operation has been basically established.

The financing standard of urban residents' serious illness supplementary insurance will increase the per capita 35 yuan, in which all the large medical expenses of urban insured residents in 20 yuan each year will be used for serious illness supplementary insurance, and the insufficient part will be included in the serious illness supplementary insurance fund according to the standard of per person 15 yuan from the basic medical insurance fund. Residents themselves will not pay extra fees.

The supplementary insurance fund for serious illness of urban residents shall be based on the principle of fixed income and expenditure, balance of payments and slight savings. The minimum deductible and maximum payment limit are set for supplementary insurance for serious illness of urban residents. The annual disposable income standard of urban households in the above table is regarded as the minimum payment standard this year, and the maximum payment limit is set at 65,438+10,000 yuan.

Supplementary insurance for serious illness of urban residents is represented by commercial insurance institutions. The commercial insurance agency is determined through government bidding. It is stipulated that the profit rate of agency commercial insurance institutions should be controlled within 5%, and all the remaining expenses paid less than 95% of the compensation target should be returned to the supplementary insurance fund for serious illness of urban residents.

Adjust the basic medical insurance for urban workers.

Measures for the administration of outpatient overall settlement

The Administrative Measures for Overall Settlement of Outpatients of Basic Medical Insurance for Urban Employees has been adjusted from four aspects, and implemented from 20 15 1. After the adjustment, the proportion of outpatient reimbursement has increased, from 50% to 60% in tertiary hospitals and from 50% to 80% in hospitals below the second level.

The designated hospitals for chronic diseases have been relaxed, from the original secondary hospitals to tertiary hospitals.

Cancel the declaration and handling of chronic diseases of Class B, increase the payment limit of outpatient co-ordination, and merge chronic diseases of Class B with general outpatient service of less than 4,000 yuan (including 4,000 yuan), and uniformly implement it according to the standard of 4,000 yuan. Class B chronic diseases with a limit of more than 4,000 yuan are adjusted to Class A chronic diseases, and they are declared and filed at any time.

The qifubiaozhun for outpatient co-ordination is set to pay 1000 yuan within one year.

Clarify and adjust the medical insurance for urban workers

Relevant policies of municipal master plan

On October 28th, 20 13/KLOC-0, the Notice on Relevant Issues Concerning the Implementation of Municipal Overall Planning of Urban Workers' Basic Medical Insurance further clarified and adjusted the relevant issues concerning municipal overall planning of urban workers' medical insurance, including six aspects:

(a) after retirement, according to the overall account combined with 8% of the insured individuals, based on 80% of the average wage of employees in this city last year, pay the basic medical insurance premium for the rest of my life in one lump sum at 6%, and enjoy the medical insurance benefits combined with the overall account after retirement; According to the overall hospitalization 4.5% of the individual insured, after retirement, still according to the proportion of 4.5% one-time payment, enjoy the overall hospitalization medical insurance benefits, not to establish a personal account. One-time payment is difficult, but it can be paid year by year according to the payment standard of on-the-job employees, and will not be paid after the remaining years are paid. Before the insured person retires, there are two kinds of payment standard information: 8% and 4.5%, and the last payment standard is the post-retirement payment standard.

(2) Farmers whose land has been expropriated who have gone through retirement procedures shall pay the basic medical insurance premium and large medical insurance premium for 20 years in one lump sum in accordance with the provisions of Order No.2 of 2004.. 1 municipal government 20 1, and enjoy corresponding medical insurance benefits after retirement. Those who have not reached the retirement age will be paid the basic medical insurance premium and large medical insurance premium in the current year in three age groups according to 4.5% of the payment base in the current year.

(three) the basic medical insurance premiums paid outside the overall planning area (including the autonomous region level) can be accumulated, but the actual insurance payment period in our city is not less than 20 years. Municipal counties are included in the insured at the city level, and the payment period can be calculated continuously in each county. When reaching the statutory retirement age, the accumulated payment period is not less than 20 years. If the urban residents' medical insurance is transferred to the urban workers' medical insurance, the urban residents' medical insurance payment can be converted according to the urban workers' payment for 2 months every full year 1 year.

(four) before 2004, 65438+February 3 1, continuous length of military service or working years were calculated as the payment period, and reached the statutory retirement age, the actual accumulated payment period in our city was not less than 15. /kloc-those who fail to pay in full in 0/5 years can pay medical insurance premiums according to Article 18 of Government Decree 20 165438 1 and enjoy medical treatment for retirees.

(5) Adjust the Qifubiaozhun of employee medical insurance hospitalization pooling fund, and the insured will be hospitalized in designated institutions for the first time within one year: 3A Hospital 1 1,000 yuan, 3B Hospital 800 yuan, Second Hospital 500 yuan, Hospitals below Second Hospital and Community Health Service Center 300 yuan. Qifubiaozhun for two or more hospitalizations is still implemented according to the provisions of government decree No.2065438 1 1. From outpatient treatment to hospitalization, charges are charged according to a qifubiaozhun.

(six) in the "notice on the implementation of the basic medical insurance for urban workers at the municipal level" issued at the same time, the abolition of the "Hohhot Municipal People's Government on the issuance of the notice" (Hufa [2007] No.4) file.

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