Notice of individual flexible employees participating in employee medical insurance in Zhaoyuan County, Daqing City

Individual flexible employees in Zhaoyuan County:

On 2002 1 July1day, individual flexible employees in our county participated in the basic medical insurance for employees. Those who meet the requirements are requested to register actively. After being insured, you can enjoy the same medical insurance benefits as employees.

I. Processing conditions

Age requirements for insurance. For the first time to participate in medical insurance for individual flexible employees, the age of participation should be less than 60 years for men and 55 years for women.

Insurance conditions for registered personnel outside the city. Individual flexible employees with household registration outside the city should participate in the basic old-age insurance for enterprise employees in our county and pay in full and on time.

Statement of serious illness. Individuals with flexible employment need to declare serious illness when they participate in medical insurance. Persons suffering from malignant tumors, hematological malignancies, severe mental illness, organ and tissue transplantation, renal insufficiency, liver cirrhosis, systemic lupus erythematosus and other major diseases and losing most or all of their working ability shall not participate in the medical insurance for individual flexible employees.

Note: Retirees of state-owned and collective enterprises that were closed and bankrupt are not restricted by the above conditions, and can apply for insurance payment at any time.

Second, the application materials

Household registration personnel in this city provide: original household registration book, home page and personal page 1 copy; Original ID card; Copy of my industrial and commercial bank card; 1 recent bareheaded 2-inch color photo.

Household registration personnel outside the city provide: original residence permit 1 copy; Copy of the industrial and commercial bank card applied by the insured in Daqing; 1 statement of endowment insurance in this city. Recently, a 2-inch color photo with no hat on a white background 1.

Third, the handling process

The insured person shall bring the corresponding application materials to five communities in the county within working days from/kloc-0 to 20 every month. After the materials are audited to meet the insurance conditions, the insured person shall fill in 2 copies of the Registration Form for Individual Flexible Employment in Zhaoyuan County to Participate in Medical Insurance, and the insured person shall sign the registration form for confirmation.

Fourth, the payment standard

Individual flexible employees participate in the basic medical insurance for employees, with large medical insurance added. 202 1, with annual payment of 3,796.2 yuan and monthly payment of 3 16.35 yuan. Pay the medical insurance premium for serious illness 180 yuan every year, and deduct it from the personal account according to the standard of 15 yuan/month.

Verb (abbreviation of verb) payment of insurance premium

Terms of payment. The premium is withheld and remitted by the county tax bureau, entrusted by the Industrial and Commercial Bank of China, and the insured deposits the premium in the next month before the end of each month. During each month 1-5, the premium will be withheld according to the total number of months in arrears, and the balance will not be withheld. If the arrears are less than 6 months, they can be withheld together with the next month's premiums after the premiums are paid in full. If the arrears exceed 6 months, the system will automatically stop the insurance, and you need to renew the insurance before you can continue to receive it.

Adjustment of payment base. The premium amount is adjusted with the average social wage base of the whole city every year. At the end of each year and the beginning of the following year, or adjust the consulting base and premium changes of five communities in the county, please pay attention to the relevant notice of the official account of "Daqing Medical Insurance" WeChat.

Sixth, medical insurance benefits.

After the treatment takes effect, the insured person can see a doctor in any designated medical institution in Daqing City, districts and counties and settle accounts online.

Personal account treatment. The insured payment starts to enjoy the treatment of outpatient personal account in the next month. At present, the amount of personal account in our county is shown in the following table.

Monthly credit amount of personnel category account

In-service 84.9 yuan

Refund 84.9 yuan

Outpatient chronic diseases and outpatient special treatment. Those who meet the conditions enjoy chronic diseases and special treatment in outpatient department. Outpatient chronic disease deductible line 600 yuan, according to the disease annual quota reimbursement, reimbursement rate is 70%. There is no qifubiaozhun for outpatient special basic treatment, and the reimbursement ratio is hospitalization reimbursement ratio; The reimbursement rate of adjuvant therapy is 80%, and the annual quota is 6,543,800 yuan.

Hospitalization. There is a waiting period of 6 months for the first insurance. Enjoy the treatment after 6 months of payment, and the reimbursement rate of basic medical insurance is 85% in service and 90% in retirement. The reimbursement rate for major risks is 85%.

Annual reimbursement limit. Basic medical care is 654.38 million yuan, and critical illness insurance is 200,000 yuan. The maximum annual reimbursement is 300,000 yuan.

Treatment during arrears. If the individual arrears of flexible employees are less than 3 months, the medical expenses during the arrears period will be reimbursed normally; If the arrears are more than 3 months but less than 6 months, the medical expenses during the arrears period can be reimbursed, but the total reimbursement shall not exceed the actual total; If the arrears exceed 6 months, the system will automatically stop the insurance, and the medical expenses incurred during the suspension will not be reimbursed, and the waiting period of half a year will be reset after the renewal.

Seven, medical insurance retirement.

Provisions on the payment period

When the insured goes through the formalities of medical insurance retirement, the cumulative payment period is: not less than 30 years for men and not less than 25 years for women. Among them, if transferred from outside the overall planning area, the local actual payment period shall not be less than 10 year. If the payment period is insufficient, it will be paid in one lump sum according to the payment base when handling the medical insurance retirement procedures.

It is regarded as the scope of payment period and supplementary base.

Our city organs, institutions, provincial units, former municipal state-owned and collective enterprises and staff outside the overall planning area were officially transferred to the above units. The length of service before 1999 can be regarded as the payment period, and it is not allowed to interrupt the payment when going through the medical insurance retirement formalities from 1999. During the interruption period, the payment base of medical insurance premium is 60% of the average social wage over the years within the overall planning scope.

Age requirement for medical insurance retirement

1. Individuals who have participated in the basic old-age insurance for enterprises and retired in the anniversary city, when men reach the age of 60 and women reach the age of 50, can go through the medical insurance retirement formalities with the Approval Form for Retirement Treatment of Basic Old-age Insurers.

2. Individuals who have not participated in enterprise endowment insurance, when men reach 60 years of age and women reach 55 years of age, can go through the medical insurance retirement procedures.

Application materials for applying for medical insurance retirement

1. The former county-owned state-owned collective enterprises provide medical insurance for retirement: a copy of the pension retirement approval form with the official seal of the department and the name of the manager; A copy of the recruitment registration form issued by the former Zhaoyuan County Labor Bureau and stamped with the official seal of the department and the name of the agent in my file; 1 copy of the original, home page and personal page of the household registration book; Original ID card; Copy of my industrial and commercial bank card; Recently, a 2-inch color photo with no hat on a white background 1.

2. Other personnel provide medical insurance for retirement: original ID card.

Self-declaration

When the insured person meets the medical insurance retirement conditions, he/she should take the initiative to go through the retirement formalities at the medical insurance window of the county administrative service center, and pay the insurance premium for less than the fixed number of years according to the relevant policies and regulations. If it is not handled in time, it will still be paid monthly according to the on-the-job status, and the medical insurance department will not notice it.

Eight, medical insurance relationship transfer

Can no longer participate in insurance. Personnel participating in employee medical insurance shall not participate in the basic medical insurance for urban and rural residents at the same time, and the basic medical insurance benefits shall not be enjoyed repeatedly. Those who have participated in medical insurance for urban and rural residents in that year need to stop urban medical insurance when transferring to individual medical insurance.

Transfer and connection of medical insurance relationship. When the working status of the insured person changes, it can be transferred from the individual to the unit, from the unit to the individual, or from the insurance relationship to the outside of the city, and the actual payment period is calculated cumulatively.

Nine, the insured information change

When the ICBC card number or mobile phone number of the insured person changes, the change formalities shall be handled in time. If the medical insurance benefits are not affected in time, the individual shall be responsible.

X. Cancellation of death

After the death of the insured, the medical insurance benefits will be automatically terminated, and the balance of personal accounts can be inherited by family members. Family members should hold the "death certificate" to the medical insurance window of the county administrative service center to terminate the medical insurance relationship within 7 days. If the medical insurance relationship is not terminated on time, resulting in additional expenses of the medical insurance fund, in accordance with the relevant provisions of the Social Insurance Law, in addition to returning the defrauded medical insurance premium, a fine of more than 2 times and less than 5 times the defrauded amount shall be imposed. If the circumstances are serious, it shall be handed over to the judicial organs for handling.

XI。 Related business handling and consultation telephone number

Songjiang community: 82 10 1 12

Chengbei community: 8239775

Nanyuan Community: 8888505

Longyuan Community: 832 15 17

Dongsheng community: 8229556

Medical insurance window of county administrative service center: 83332 19.

Zhaoyuan county medical treatment security bureau

20212 August